LIBRARY OF CONGRESS, 



?ap.- - @aptjri$fi lfo t . 

Shell 




UNITED STATES OF AMERICA. 




NURSING IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 



FULLERTON. 



BY THE SAME AUTHOR. 



A HANDBOOK 



OBSTETRICAL NURSING. 

Comprising the Course of Instruction in Obstetrical Nursing 

given to the Pupils of the Training School for Nurses 

connected with the Woman's Hospital of Philadelphia. 

BY ANNA M. FULLERTON, M.D., 

Demonstrator of Obstetrics in the Woman's Medical College of Pennsyl- 
vania ; Physician-in- Charge and Obstetrician and Gynecologist to the 
Woman's Hospital of Philadelphia, and Sziperintendent of the 
Nurse Trai?iing School of the Woman' 's Hospital of Philadelphia. 

34 Illustrations. 12mo. Handsome Cloth, $1.25. 

SECOND EDITION— REVISED. 

Synopsis of Contents. — Signs of Pregnancy — Management of 
Pregnancy — Accidents of Pregnancy — Preparations for the Labor 
— Signs of Approaching Labor and the Process of Labor — Duties 
of the Nurse during Labor — Accidents and Emergencies of Labor 
— Care of the New-born Infant — Management of the Lying-in — 
Characteristics of Infancy in Health and Disease — The Ailments of 
Early Infancy — Index. 

" It is a book that I have recommended since I first saw it, and we are using 
it for our nurses at the N. Y. Infirmary, where we have a branch of our School, 
our nurses going there for instruction in obstetrics." — Mrs. L. W. Quintard, 
Supt. Connecticut Training School for Nurses, New Haven, Conn. 

'• It is the most modern and complete book I have ever read for the care of 
obstetrical patients. I shall take pleasure in recommending it to this school for 
study." — E. L. Warr, Supt. Training School for Nurses, City Hospital, St. 
Louis, Mo. 

" I have looked it over and read it with care, and think it is the best book I 
have ever seen on the subject. It is practical, with plain instructions, nothing 
superfluous. A good book for nurses and teachers of nurses." — Miss Anna 
G. Clement, Supt. of Nurses, The Henry W. Bishop Memorial Training 
School for Nurses, Pittsfield, Mass. 

" I consider the book excellent in every particular. Would recommend it to 
every nurse, whether she did obstetrical nursing or not." — Gertrude Mont- 
fort, Supt. of Nurses, New England Hospital for Women and Children, 
Boston, Mass. 

" What is to be learned in a maternity training school is the way to nurse as a 
profession. * * * Can recommend it as a valuable manual." — From the Ante r- 
ica7i Journal of Medical Sciences. 

P. BLAKISTON, SON & CO., Publishers, Philad'a. 



NURSING IN 



ABDOMINAL SURGERY 



DISEASES OF WOMEN. 



A SERIES OF LECTURES DELIVERED TO THE PUPILS OF THE 

TRAINING SCHOOL FOR NURSES CONNECTED WITH 

THE WOMAN'S HOSPITAL OF PHILADELPHIA, 

COMPRISING THEIR REGULAR COURSE OF 

INSTRUCTION ON SUCH TOPICS. 



J 



BY 



ANNA MfFULLERTON, M.D., 

PHYSICIAN-IN-CHARGE OF AND OBSTETRICIAN AND GYNAECOLOGIST TO THE 
WOMAN'S HOSPITAL OF PHILADELPHIA, ETC. 



ILLUSTRATED. 





DEC 3 139! 

P. BLAKISTON, SON & CO., 

IOI2 WALNUT STREET. 
189I. 



O 



'■ y\ 



Copyright, i 891, by Anna M. Fullerton, m.d. 



PRESS OF WM. F. FELL & CO., 

1220-24 SANSOM STREET, 

PHILADELPHIA. 



I- 



TO 

The Woman's Hospital of Philadelphia, 

WHERE MANY WOMEN, 

BOTH PHYSICIANS AND NURSES, 

HAVE BEEN TRAINED FOR EFFICIENT SERVICE 

IN THE CARE OF THE SICK, 

I RESPECTFULLY DEDICATE 
THIS BOOK. 



PREFACE 



Many books have been written within recent 
years on the subject of abdominal and gynaecolog- 
ical surgery, for the instruction and guidance of the 
medical student and practitioner, yet none but the 
most meager details — found chiefly in books on 
general nursing — have been supplied for the aid of 
the nurse. 

The stringent requirements of aseptic and anti- 
septic surgery demand that nurses and assistants 
shall cooperate with the surgeon in enabling him 
to attain the results desired in operative work. 
Hence a thorough knowledge of the methods by 
which the best results are to be obtained is essen- 
tial. At the request of my pupils — and with the 
hope of meeting this need in other institutions — 
I have prepared these lectures for publication. 
The methods recommended are those which have 
proved useful and successful in the surgical work 
of the wards of our Hospital. An effort has been 
made, however, by careful observation of the work 
in prominent hospitals both in this country and 
Europe, as also by a thorough study and com- 

vii 



Vlll PREFACE. 

parison of the methods advocated by standard 
writers, to represent the various plans of manage- 
ment which tend to serve the same end. 

The chapter on diet for the sick has kindly been 
prepared by our matron, Miss Sara H. Janvier, and 
contains recipes for invalid cookery which are 
taught our nurses in the diet kitchen connected 
with the Hospital, in which each nurse has a 
term of service. 

I am indebted to Dr. Anna E. Broomall for many 
practical points in connection with the methods of 
management set forth in this book; also, to Dr. 
Susan Hayhurst, Dr. Frieda E. Lippert, and Miss 
Alice Littell for aid in its compilation. To all who 
have helped me by friendly counsel and assistance 
I would express my sincere thanks. 

ANNA M. FULLERTON. 

Woman's Hospital of Philadelphia, 
October, i8gi. 



CONTENTS. 



CHAPTER I. p AGE 

The Surgical Nurse, 17 

CHAPTER II. 
The Germ Theory of Disease, 25 

CHAPTER III. 
Asepsis and Antisepsis, 30 

CHAPTER IV. 
Abdominal Section, 42 

CHAPTER V. 
The Preparation of the Room, 49 

CHAPTER VI. 
The Preparation of Sponges, 6y 

CHAPTER VII. 
Sterilization of Instruments, Etc., 73 

CHAPTER VIII. 
Preparation of the Patient, 90 

CHAPTER IX. 
Preparation of Operator and Assistants, 99 

CHAPTER X. 

The Nurse's Duties during Operation, 102 

ix 



X CONTENTS. 

CHAPTER XL PAGE 
The Nurse's Duties after Operation and during Con- 
valescence, ... 106 

CHAPTER XII. 
Management of Complications, 136 

CHAPTER XIII. 
The Pelvic Organs in Women, 157 

CHAPTER XIV. 
Diseases of Women, 164 

CHAPTER XV. 
General Nursing in Pelvic Diseases, 173 

CHAPTER XVI. 
Preparations for Gynaecological Examinations, ... 190 

CHAPTER XVII. 
Preparations for Gynaecological Operations, .... 204 

CHAPTER XVIII. 
Preparation of Patient, Operator and Assistants, . 214 

CHAPTER XIX. 
Duties of Nurse during Operation, 219 

CHAPTER XX. 

Special Nursing in Gynaecological Operations, . . . 222 

CHAPTER XXI. 

Diet for the Sick, 256 

Index, 281 



ILLUSTRATIONS. 



FIG. PAGE 

1. Sterilizing Oven, 32 

2. Abdominal Organs, 43 

3. Vertical Section of Pelvic Organs, 44 

4. Steam Atomizer, 53 

5. Diagram showing Position of Operator, Assistant, etc., . . 59 

6. Diagram showing Position of Operator, etc., when two 

Assistants, 60 

7. Glass Graduate with Thermometer, 64 

8. Apparatus for Irrigation of Abdominal Cavity, ..... 66 

9. Arnold Steam Sterilizer, 74 

10. Ignition Tube, cont. Glass Reels, wound with Silk, etc., . 82 

11. Ignition Tube, cont. Glass Reels, 82 

12. Needle Holder, 84 

13. Scalpels, 85 

14. Pressure Forceps, 85 

15. Grooved Director, 85 

16. Curved and Bent Scissors, 86 

17. Trocar and Canula, 86 

18. Volsella, 86 

19. Cyst Forceps, 87 

20. T-Forceps, 87 

21. Retractor, 88 

22. Pedicle Needle, . . . 88 

xi 



Xll ILLUSTRATIONS. 

FIG. PAGE 

23. Serre Noeud, 88 

24. Pedicle Pins, 89 

25. Aseptic Razor with Metal Handle, 92 

26. Arrangement of Operating Pad in Abdominal Section, . . 97 

27. Hypodermic Needles and Syringe, 108 

28. Davidson Syringe, , 1 10 

29. Glass Catheter, ...116 

30. Coach Urinal, H7 

31. Female Urinal, 118 

32. Feeder, . 121 

^. Slipper Bed-pan, . 122 

34. Eureka Bed-pan, 122 

35. Rubber Air-cushion, 124 

36. Glass Drainage Tube, .... 125 

37. Glass Syringe for Draining Tube, . . 125 

38. Hard Rubber Syringe for Draining Tube, 126 

39. London Supporter, 134 

40. Elastic Abdominal Bandage, 135 

41. Leiter's Tube-cap, 139 

42. Rubber Water-coil, 141 

43. Cradle for Supporting Bed-clothes, 146 

44. The External Genitalia, 158 

45. The Internal Genitalia, 160 

46. Equipoise Waist, 167 

47. Fountain Syringe, 180 

48. Rubber Bed-pan, 183 

49. Utero- Vaginal Irrigator, 184 

50. Vaginal Nozzle with Reverse Current, 185 



ILLUSTRATIONS. Xlll 

FIG. PAGE 

51. Chadwick's Gynaecological Table, 193 

52. The Uterine Sound, . 195 

53. Bi-valve Speculum, 195 

54. " Speculum, Small, 196 

55. Cylindrical Speculum, 196 

56. Sims' Speculum, 197 

57. Dressing Forceps, 198 

58. Sims' Position, or Semi-prone Position, 201 

59. Genu-pectoral Position, 202 

60. Operating Pad, 207 

61. Leg-holder, 216 

62. Dorsal, or Lithotomy Position, 217 

63. Anatomical Forceps, 229 

64. S-shaped Catheter, 234 

65. Bulbous Catheter, 235 

66. Paquelin's Thermo- cautery, 239 

67. Aspirator and Needle, ' 243 

68. Intra-uterine Return Catheter, 244 

69. Bistouries, 250 

70. Diagram of Nurse Report, 255 



" So kind, so duteous, diligent, 
So tender over (her) occasions, true, 
So feat, so nurse-like ! " 

Shakespeare's Cymbeline, iv, 5. 

" Ask God to give thee skill in comfort's art 
That thou mayst consecrated be and set apart 
Unto a life of sympathy ; 

For heavy is the weight of woe in every heart, 
And comforters are needed much of Christ-like touch.' 1 

Unknown. 



NURSING 

IN 

ABDOMINAL SURGERY 

AND 

DISEASES OF WOMEN. 



CHAPTER I. 

THE SURGICAL NURSE. 



" A perfect nurse, " says the surgeon, J. Grieg Q ualific 



Smith, in his celebrated work on Abdominal Sur- 
gery, " is a perfect woman, rarely to be had." There 
are possibilities of perfection, however, in every 
human being of average health and ability. Both 
men and women fail oftener in attaining a high 
degree of excellence in character and work from 
indolence rather than incompetency, 

" Energy of will — self-originating force — is the 
soul of every great character. Where it is, there is 
life ; where it is not, there is faintness, helplessness, 
and despondency." Energy of will is largely a 

17 



tions for 
nursing. 



1 8 NURSING IN ABDOMINAL SURGERY. 

matter of self-discipline, and it is one of the first 
requisites to success in nursing as in other pro- 
fessions. 

A serene, sunny disposition is another important 
qualification in a good nurse, for it serves to pro- 
duce an atmosphere of quiet content in the sick- 
room which conduces greatly to the comfort and 
well-being of the patient, as of all concerned. 

Self-forgetfulness, sympathy, cheerfulness, pa- 
tience, tact, quickness of observation, method and 
skill in action, implicit obedience and loyalty to her 
physician — all of which are so essential to the good 
nurse — are the fruit of long and careful self-disci- 
pline combined with practical experience. 
Necessity The surgical nurse should be habituated to the 

tor tram- 

ing. sight of blood. She should be strong-nerved and 

of steady hand. Sudden emergencies should not 
throw her off her guard. Thorough training and 
a knowledge of the conditions which may demand 
prompt action on her part will enable her to attain 
the necessary self-possession. Knowledge gives 
courage. Skill is gained by practice. For the 
acquirement of knowledge and skill it is essential 
that the surgical nurse should have a course of 
training in the wards of a hospital where consid- 
erable surgical work is done. 

So much does the success of a surgeon's work 
depend upon the nurse that extreme care should 



THE SURGICAL NURSE. 1 9 

be exercised in the selection of a suitable person 
to undertake the supervision and after-care of an 
operative case. 

It is to be hoped that the training-schools of our 
country will greatly increase the number of nurses 
fitted to assume these important trusts. 

Personal cleanliness is essential in every nurse. 
This does not imply a simple adherence to the 
ordinary rules for bathing and general care of the 
person. " Surgical cleanliness aims at the removal cieanuLss 
of microscopic particles," hence requires a thorough 
appreciation of the principles of asepsis and anti- 
sepsis. The danger of a nurse's carrying disease 
from one patient to another makes it imperative 
that her entire body, including her hair, should 
receive a thorough cleansing between the different 
cases she may nurse. After the general bath of 
warm water and soap, the surface of the body 
should be washed with an antiseptic solution ; as, 
corrosive sublimate (i-iooo); Labarraque's solu- 
tion of chlorinated soda (i part to 8 of water) ; 
or carbolic solution (1-40). The chlorinated soda 
solution should not be used on the hair because 
of its bleaching effect. The irritation of the skin 
produced by any of the antiseptic washes may be 
prevented by a subsequent plunge or sponge bath 
of simple warm water. 

The costume of a nurse is another matter of nurse" 16 ° f 



20 NURSING IN ABDOMINAL SURGERY. 

great importance. Apart from its being neat and 
clean, the entire costume should consist of wash 
materials to insure its being free from contagion. 
Without previous washing no articles of dress 
should be worn in attendance upon two different 
cases. 
rfdodSng? Clothing worn at a contagious case should be 
allowed to soak in an antiseptic solution from one to 
two hours before its subjection to the ordinary pro- 
cesses of the wash. 

Care should be taken to rinse out the antiseptic 
solutions very thoroughly before boiling the cloth- 
ing, as the chemical agents ordinarily used might 
otherwise produce discoloration. Corrosive subli- 
mate (i-iooo) and carbolic solution (1-20) are the 
agents usually employed. A preparation which 
has been satisfactorily employed in many hospitals 
for washing infected clothing is the following : Four 
ounces of sulphate of zinc, and two ounces com- 
mon salt dissolved in 1 gallon of water. The 
clothing may be boiled in this for half an hour and 
lie in the solution from 4 to 5 hours. 

The bleaching effect of chlorine prevents the use 
of this for colored clothing. Boiling the clothing 
for half an hour would cause its thorough disin- 
fection, but as care should be taken not to subject 
those who attend to the washing to danger from 
infection, and since many laundresses cannot be 



THE SURGICAL NURSE. 21 

trusted to boil the clothing, it is a safe plan to sub- 
ject it to this double process of cleansing. The 
methods of disinfection for various articles will be 
more thoroughly dwelt upon in another chapter. 
I touch upon the matter here in order to impress 
the nurse with the fact that a thorough disinfection 
of herself is as important as that of her patient and 
his surroundings. 

During an operation the nurse should wear an ^117x1™ 
entirely fresh suit of clothing, and, if she is obliged tlon * 
to handle sponges or so assist the surgeon as to 
come in contact with him or the patient, a large 
clean apron and fresh slip-sleeves should be put on 
after all things else are in readiness for the operation. 
The especial precautions to be taken in the prepa- 
ration of her hands for her work are as follows : — 

The nails should be kept closely cut, the hands cleansing 

and care of 

smooth and soft, that they may not feel rough to hands - 
the patient as they come in contact with his skin. 
Cold cream or a little glycerine rubbed over the 
hands at night; or, if the skin be irritated by pure 
glycerine, the use of a wash consisting of bay-rum 
(^3) and glycerine (^), makes a nice lotion for the 
hands. 

Work properly done need not spoil the hands, 
provided the precaution be taken after washing 
them to dry them thoroughly, and to anoint them 
as suggested, when rough. 



22 NURSING IN ABDOMINAL SURGERY. 

Should the nurse's hands come in contact with 
foul discharges, a first cleansing with soap and cold 
water will best help to remove the odor. Warm 
water with soap may then be used with a nail-brush 
for more thorough removal of all particles of dirt, 
and then some antiseptic, as chlorinated soda. In 
the special cleansing of the hands for surgical 
work, various methods may be followed. Thus 
after a thorough cleaning with soap and water for 
several minutes, the nail-brush being carefully 
used, the hands may be immersed in an antiseptic 
wash, which is similarly thoroughly applied by 
means of a nail-brush around the finger-nails, etc. 
Pure alcohol may be used, or corrosive sublimate 
solution i-iooo, or Labarraque's solution 1-8. 

A method employed in some hospitals for steril- 
izing the hands is described as follows : Ten 
minutes are spent in washing the hands, finger- 
nails, and fore-arms with brown (oleine) soap and 
warm water and a moderately stiff scrubbing brush. 
After washing thoroughly in water and soap, the 
hands are next immersed in a saturated solution of 
permanganate of potash, and held there until they 
are uniformly deeply stained ; from this they are 
transferred to a saturated solution of oxalic acid, 
which removes the stain in one minute. They are 
then dipped in plain water and finally laid in a bath 



THE SURGICAL NURSE. 23 

of bi-chloride of mercury (i-iooo) for a full min- 
ute.* 

A nurse should keep her breath sweet. The Careof 

1 # m breath. 

existence of a bad catarrh will incapacitate her 
for surgical nursing. The mouth and teeth and 
the digestive organs should also receive the atten- 
tion they demand, so that the patient may suffer 
no annoyance from their effect upon the breath. 

It should not be necessary to remind a nurse of Personal 

J hygiene. 

the importance of attention to her own health. An 
earnest purpose to attain the highest success in her 
work should lead every nurse to so dispose of her 
hours of leisure as to keep herself in the best 
working order. " This one thing I do," should be 
her motto ; and food and drink, clothing, rest, and 
recreation should be so adjusted as to train her for 
active duty, and for the strain which must often 
come to her in the long vigils of the sick-room, 
when every sense should be acute to discover the 
slightest change in the sufferer, and every faculty 
fully alive to the demands of the moment. Acute 
conditions demanding the almost constant presence Soieman- 

x agement 

of the nurse seldom last longer than a few days, desirable. 
and a well-trained nurse can ordinarily bear the 
strain very well for that length of time. Should the 
critical condition be protracted, it may be necessary 

*Dr. H. Kelly. 



24 NURSING IN ABDOMINAL SURGERY. 

to have a division of labor by association with 
another nurse. 

It is so much more satisfactory for one nurse to 
manage a case throughout, that, unless it is im- 
perative, such an arrangement for sharing work 
should be avoided. The assistance of some reliable 
member of the family, at times when the patient is 
not requiring very especial attention, will often 
permit a most trying case to be carried through with 
but one nurse's supervision. 

The simplest and most wholesome food and 
drink, regular out-door exercise, sufficient sleep at 
a time when sleep is legitimate, good sense in the 
matter of dress, occasional change of scene and 
thought in the intervals between cases, will help to 
keep a nurse in good condition for duty. 

" What is there in the world to distinguish 
virtues from dishonor, or that can make anything 
rewardable, but the labor and the danger, the pain 
and the difficulty?" — Jeremy Taylor. 



CHAPTER II. 

THE GERM THEORY OF DISEASE. 

In order to thoroughly understand the import- 
ance of the minute details to be observed in sur- 
gical nursing, it is essential that the nurse should 
know something of the researches of modern 
science which have developed what is called the 
" germ theory of disease." 

" Germs " or " bacteria " are forms of life so Description 

of" germs. 

minute as to be singly invisible to the naked eye. 
Numerous forms of bacteria have, however, been 
carefully examined and studied through the micro- 
scope, and scientists have thus in recent years 
learned much of their nature and activities. These 
researches have proved a most valuable contri- 
bution to the science of medicine, for through them ^ntific 
it has been found that many of the most deadly 
processes of disease are due to the irritating pres- 
ence of special germs and to the changes which 
they bring about in the human body. 

The causation of disease as induced by these 
minute organisms, and its prevention by suitable 
management, are subjects of such great import- 

25 



research. 



26 NURSING IN ABDOMINAL SURGERY. 

ance that scientific workers all over the world are 

devoting time to the study of bacteria, with the 

hope of eventually exterminating some of the 

Diseases present most fatal maladies. Thus consumption, 

and dis- x L ' 

eased con- typhoid fever, cholera, diphtheria, and pneumonia 

ditions due J r } ' r > r 

to germs. are due j- germs, each disease having its own 
specific cause. The same may be said of surgical 
diseases, — the complications which may arise in the 
healing of wounds ; as, inflammations, abscesses, 
erysipelas, and the various forms of blood-poison- 
ing. 

Properties Bacteria exist almost everywhere. They have 

of bacteria. . . 

the power of nourishing themselves by using certain 
portions of dead organic material, leaving the rest 
in such form as to be used by other living things. 
They also have the power of moving and of repro- 
Conditions ducing their kind. Warmth, moisture, and a certain 

necessary to 

development amount of organic matter, are the conditions which 

of germs. ° 

favor their development. Most, but by no means all, 
forms of bacteria require air ; some, however, can 
develop only in the absence of air. 
Rapidity of Where the conditions are favorable they may 

increase. . . 

increase with great rapidity. 1 he process of repro- 
duction is as follows: One of the bacteria grows 
a little longer, a constriction forms about the middle 
which finally becomes a complete partition, so that 
Method of two distinct individuals are thus formed. These 
tfo P n° uc similarly divide to produce other bacteria, and their 



THE GERM THEORY OF DISEASE. 2J 

number thus multiplies. These separate bacteria 
may fall apart or cling together in chains or in 
masses. The figures giving us the estimate of the 
rapidity with which they reproduce themselves, 
seem almost fabulous. Thus it has been authenti- 
cally stated that a single germ by this process of 
growth may in twenty-four hours give rise to 
more than sixteen and a-half millions. 

Bacteria are of various shapes ; the most frequent Forms un- 
der which 

are the round, oval-shaped, rod-shaped, or spiral- bacteria 
shaped. To give an idea of their size it has been 
said that of one of the most common forms of 
bacteria (a little rod), were fifteen hundred of them 
put end to end, they would scarcely reach across 
the head of an ordinary pin. 

The different species of bacteria are very numer- species. 
ous. These organisms are to be found wherever 

. . Substances 

any form of life can exist — in water, in the atmo- and locaii- 

ties in which 

sphere, in the soil, in our food and drink, especially found. 
that which is uncooked ; in all the orifices and 
canals of our own bodies which communicate with 
the air, wherever dust can go or collect, there are 
bacteria of various forms in greater or smaller 
numbers. 

When the bacteria are dry they are said to be condition in 

. . .1 . i 1 r • • i which inactive. 

inactive, as they are not capable of increasing and 
multiplying as they do where moisture and the 
special food they need is present. Of the special 



28 



NURSING IN ABDOMINAL SURGERY. 



Species 
that infect 
wounds. 



Streptococ- 
cus. 

Staphylo- 
coccus. 



Method of 
infection. 



( Ptomaines. 



Pyogenic 
bacteria. 



forms of bacteria which are apt to infect wounds, 
it has been found that there are two particular 
species which give the most trouble in the majority 
of cases. These are round in shape and are called 
" micrococci." One species in growing forms 
chains and is called Streptococcus, the other forms 
clusters like bunches of grapes and is called 
Staphylococcus. 

Both these forms of bacteria exist very abun- 
dantly in dirty places, even where healthy people 
live, but especially where the sick are crowded 
together. Therefore they are especially to be 
guarded against in hospitals. 

They are found floating in the air or resting with 
the dust upon any surface exposed to the air. 
When dust falls upon the open surface of a wound, 
or any object upon which bacteria rest comes in 
contact with such a surface, these living organisms 
lodge in the wound, and if not destroyed grow 
• there, forming poisonous materials called " pto- 
maines," which interfere with the proper healing of 
the wound. Poisonous materials may even thus 
gain access to the blood and be carried to distant 
parts of the body, where they continue to develop. 
The whole system may then become infected with 
the poison, causing serious and often fatal results. 

In the occurrence of inflammatory complications 
in the healing of wounds, pus in greater or less 
quantity is apt to be produced. For this reason 



THE GERM THEORY OF DISEASE. 29 

the bacteria causing such complications are called 
pus-forming or pyogenic bacteria. 

This representation of the irritating nature of 
bacteria under especial conditions is not intended 
to convey the idea that they are entirely destructive 
in their tendency. Like all things else in nature, pes of 

J o ' bacteria in 

they have a special purpose to serve. They break nature - 
or tear up worn-out material and thus get it in 
readiness for new uses — much as a pair of scissors 
will rip up an old garment and get it in readiness for 
re-fashioning. Only the bacteria, unlike the scissors, 
accomplish this work of separating the particles of 
matter by appropriating to themselves certain sub- 
stances which serve for their own nutrition. 

It is only when the condition of the body, or any 
part of the body, is such as to favor the rapid mul- 
tiplication of these germs that diseased conditions 
may be induced. 

If the standard of health is maintained by due Security 

J against their 

attention to physiological and sanitary principles, fg5* ctive 
even those liable by heredity to special forms of 
disease may do much to resist the deleterious 
effects induced by the presence of germs. 

We would, therefore, in this connection remind Hygienic 

precautions. 

the nurse of the subtle influences of sunlight, fresh 
air, good food, cleanliness, and cheerfulness, which 
will enable her, in the care of the severest cases of 
illness, to successfully meet and resist the attacks 
of the unseen but ubiquitous foe. 



CHAPTER III. 

ASEPSIS AND ANTISEPSIS. 
Definitions The word " clean " is derived from an old Saxon 

of terms. 

term, " claene," which signifies " to open, to remove, 
to separate." The term " cleanliness," therefore, 
implies a condition of absolute freedom from all 
extraneous or foreign matter. 

Surgical cleanliness refers more particularly to 
the absence of all germs of putrefactive change. 

The words " aseptic " and " antiseptic," so con- 
stantly used by the surgeons of the day, come from 
a Greek root> the word " septos," meaning " putrid." 
Asepsis means literally "without putrefaction." 
The germs of putrefactive change may never have 
been present, or if once present, should have been 
entirely destroyed in any object which is termed 
" aseptic." 

Antisepsis means " against sepsis or putrefaction," 
and comprises the means or methods by which 
objects may be rendered "aseptic." Any sub- 
stance in which all germs have been destroyed by 
antiseptic measures, is said to be "sterilized" because 
the germs have been rendered incapable of doing 

30 



ASEPSIS AND ANTISEPSIS. 3 1 

further injury by continued reproduction. The 

application of a high degree of heat — dry or -moist 

— and the use of certain chemical agents constitute 

the measures by which germs may be rendered 

harmless. 

In sterilizing inanimate things heat is generally steriiiza- 
& & ° J uon of in- 

employed. Instruments, towels, clothing, etc., may ^™™ s en ^ 

thus be sterilized by either dry or moist heat. 
In the use of dry heat it is essential to attain 
a temperature considerably above the boiling 
point of water, — at least 230 Fahr. (no C). 
In the disinfection of articles supposed to contain 
spores (the seeds or eggs of bacteria) it is well 
to employ this degree of heat for 2 hours. 
Furnaces or ovens of special design are employed 
for sterilization by this means, as also for the use st'ediTza- 
of steam under pressure. In the latter case the 
temperature should be raised to 22 1 ° Fahr. (105 ° C). 
For office or hospital work instruments must be 
kept constantly ready for use, and a small sheet- 
iron oven, heated by gas, such as is used for office 
bacteriological work, may be employed. This is 
provided with a thermometer and with a thermostat, 
by which the flow of gas is automatically controlled, 
so that the heat is maintained within known limits. 
The instruments should be subjected to this heat for 
about one hour. With steam, which is more pene- 
trating than dry heat, ten to fifteen minutes is 



oven. 



32 



NURSING IN ABDOMINAL SURGERY. 



sufficient for purposes of sterilization. It is not 
uncommon, however, for greater security, to leave 
the articles in the steamer longer, as for an hour. 



Fig. 




Sterilizing Oven. 



Boiling in water for the same length of time is 
also sufficient, unless the article be bulky, when it 
is well to extend the time to a half hour. The 



ASEPSIS AND ANTISEPSIS. 33 

Arnold steam sterilizer is perhaps the most con- Arn °w 

1 x steam 

venient arrangement for the sterilization of instru- sterilizer - 
ments, towels, etc., and is in use now in most 
hospitals. It consists of a pan, which contains the 
water to be heated, communicating with a closed 
chamber in which the steam accumulates. The 
articles to be sterilized are placed in this chamber. 
A double lid is arranged for the prevention of escape 
of steam. (See Fig. 9.) 

Water itself is rendered aseptic by filtering and sterilization 

. . of water. 

boiling, or distilling and boiling. Distilled water 
should be entirely aseptic, but its manufacturers 
rarely appreciate the minute details of asepsis suf- 
ficiently to take proper precautions to prevent con- 
tamination. Hence, even when distilled water is 
employed for an operation, it is well for the nurse 
to take the precaution of boiling it in vessels which 
she knows to be clean. Water thus sterilized is 
made fit for contact with open wounds. Neither 
rain water nor melted ice will serve as a substitute 
for water thus prepared, as they are not free from 
germs. 

In the many cases in which heat cannot be used, as 
in the sterilization of living tissues, chemical agents 
are employed in solutions of suitable strength, or 
in the form of powder. The agents thus used are 
termed " antiseptics," and may be employed accord- Antiseptics. 
3 



34 NURSING IN ABDOMINAL SURGERY. 

ing to their properties and the strength of their 
solutions, for one of two purposes, — either as 
" germicides,'' true germ-killers, or as " inhibitory 
agents," that is as substances which check the 
activity of germs and thus prevent their injurious 
action. True germicides are so poisonous that they 
cannot be used except in very dilute solutions 
when brought in contact with living tissues. In 
fact, even dilute solutions have been known to 
cause poisoning by absorption ; hence more and 
Asepsis in m0 re in wound surgery the use of boiled distilled 

deep-wound ° J 

surgery. water, or boiled filtered water, is replacing the 
use of antiseptic solutions. Especially is this the 
case in the surgery of the internal organs. The 
use of antiseptic washes is more frequent in the 

Surface treatment of surface wounds, accompanied by a 
foul discharge. 

Antiseptic agents in sufficient strength to be 
germicidal are, therefore, only used for the destruc- 

Germiddes. tion of germs in putrescent substances outside the 
body. Thus, typhoid stools, diphtheritic discharges, 
etc., should be rendered innocuous by the strongest 
germicides available. Such use should be kept 
entirely distinct from their application in wound 
surgery. 

The following list gives those most commonly 
employed for germicidal effect. 



ASEPSIS AND ANTISEPSIS. 35 

I. Chloride of lime solution, 4 per cent, made by 
adding 6 ounces to the gallon of water. 
II. Bichloride of mercury (corrosive sublimate) 
solution 1-500, that is 15 grains to the pint. 

The above are the best chemical solutions to 
employ for the disinfection of spore-containing 
material. 

(a) Chloride of lime in powder is a good disinfect- Disinfection 

v J 10 of waste 

ant for sprinkling over masses of organic organic 

r & & matter. 

material in privy vaults, etc. It has been 
estimated that about one pound of chloride 
of lime is required for every thirty pounds of 
such material. Should corrosive sublimate 
be used for the purpose, one pound of the 
powder for every five hundred pounds of 
faecal matter will be sufficient 

(b) Slaked lime in the proportion of about one per 

cent, that is one pound to the hundred of 
the material to be treated, has been shown 
recently to be an efficient germicide. 

(c) Copperas (sulphate of iron), or green vitriol, in 

the proportion of \y 2 pounds to a gallon of 
water, is a valuable agent for the arrest of 
putrefactive decomposition, being readily 
available because of its low price. 

These substances are all of great value where it 
is impossible to remove filth from the vicinity of 



36 NURSING IN ABDOMINAL SURGERY. 

houses, but they are a poor substitute for cleanli- 
ness. 

Disinfection For the disinfection of discharges in the sick- 
ox sick-room ° 

discharges. r0 om, the solutions ordinarily employed are — 

I. Corrosive sublimate (1-500), 15 grains to the 
pint of water. 
II. Chloride of lime (4 per cent.), 5 drachms to the 
pint. 

III. Carbolic acid (5 per cent.), about ^ of an 

ounce to the pint. 

IV. Sulphate of copper (5 per cent.), about ^ of 

an ounce to the pint. 

Sunder- 011 Underclothing, bedding, etc., if infected, are best 
blddinf; destroyed by fire, if of little value. 

To disinfect them, we may employ — 

(a) Boiling for at least a half hour. 

(&) Boiling for half an hour in a solution of 4 

ounces sulphate of zinc, 2 ounces common 

salt, to 1 gallon of water. 

(c) Immersion for three or four hours in a solution 
of corrosive sublimate, 1-1000. 

(d) Immersion in a 5 per cent, carbolic solution 
for the same length of time. 

To avoid the discoloring effects of these solu- 
tions, clothing taken from them should be thor- 
oughly rinsed out in clear water before it is sent 
to the laundry. 



etc. 



ASEPSIS AND ANTISEPSIS. 37 

Outer garments, which would be injured by boil- 
ing water or a disinfecting solution, may be steril- 
ized — 

(a) By exposure to dry heat at a temperature of 

230 Fahr. (no° C). 

(b) By the steaming process in a suitable apparatus. 

Mattresses and blankets should be disinfected in 
the same way. If these means are not available, 
mattresses may have their covering removed, and 
washed and boiled separately, the contents being 
immersed in boiling water for a half hour. 

Furniture, floors, wood-work, painted walls, etc. of Disinfec- 

J x tion of fur- 

a room should be washed with either — "hire, etc. 

(a) Corrosive sublimate solution (1-1000), which 

is most efficient, or — 
(d) Carbolic acid solution 2 per cent. 

Rooms are generally disinfected by burning sul- Disinfec- 
phur in the proportion of at least 3 pounds for room - 
every thousand cubic feet of air space. To secure 
any good results close the apartment as closely as 
possible by stopping up all apertures through 
which the gas might escape, by means of wet rags 
which may be stuffed into the cracks around doors, 
windows, etc. The sulphur is put into a deep tin 
pan which is placed upon two bricks, in a tub 
partly filled with water, in the middle of the room. 



38 NURSING IN ABDOMINAL SURGERY. 

A little alcohol may be poured on the sulphur, 
which is then set on fire, or a few live coals placed 
in the pan. The fumes should be kept in the 
apartment from twelve to twenty-four hours, after 
which doors and windows should be thrown open, 
and it should be subjected to free ventilation. All 
surfaces in the room are then washed off with one 
of the above-mentioned solutions. 
S is thI eC el°- n F° r the disinfection of the surface of the body, 
son - after a thorough wash with soap and warm water, 

use may be made of — 

I. Absolute alcohol, as in cleansing the hands 

(too expensive for general use). 
II. Solution of corrosive sublimate, 1-1000. 

III. Solution of chlorinated soda, 1-10. 

IV. Carbolic acid solution, two per cent. 

V. Saturated solution of permanganate of potas- 
sium, followed by the saturated solution of 
oxalic acid. This should be used for the 
hands alone, according to the method de- 
scribed in the chapter on the Surgical 
Nurse. 

cleansing Open wounds or raw surfaces are cleansed pre- 
wounS. ferably with boiled distilled water. When dirt has 

entered the wound, or pus has formed, showing the 

presence of germs, we may use — 



ASEPSIS AND ANTISEPSIS. 39 

I. Solution of corrosive sublimate, 1-4000, I- 

5000, etc. 
II. Carbolic solution, 2 per cent. 
III. Beta-naphthol solution, 1-2500. 

A preparation used much of late for pus-secret- 
ing cavities and surfaces, is peroxide of hydrogen 
(hydrogen dioxide), which has no equal either for 
safety or efficiency. The compound is so unstable 
that, unless the bottle containing it be kept very 
firmly and securely corked, in the intervals of its 
use, it will lose its virtue. It should always be 
kept in a dark, cool place, and should not be shaken 
violently. 

For surgical dressings we do not so much need Surgical 
germicides as inhibitory agents. The various dressin § s - 
gauzes as ordinarily prepared with bichloride of 
mercury, boric acid, carbolic acid, eucalyptus, sali- 
cylic acid, etc., serve this purpose, as does the use 
of iodoform, aristol, or boric acid in powder. 

Bichloride of mercury, or corrosive sublimate p re para- 
gauze, is that most generally preferred. To pre- bichloride 
pare it the gauze is allowed to soak for an hour in §auz< 
a sud of soft soap to remove all " sizing." It is 
then wrung out of clear water several times until 
the soap is well out of it, and is immersed in a 
solution of corrosive sublimate, 1-100(75 grains to 
the pint of water), or a weaker solution, as 1-1000, 
may be used. It is then dried in an oven. As 



40 NURSING IN ABDOMINAL SURGERY. 

drying the gauze in this way, especially if the 
temperature of the oven be raised high enough to 
bake it, has the effect of rendering it non-absorbent, 
it is desirable either to sprinkle a little glycerine 
over the layers of gauze before drying, or to put a 
small quantity in the corrosive sublimate^ solution 
used in its preparation. After this process the 
gauze should be kept carefully from dust and con- 
tamination by contact with unsterilized substances. 
It may be rolled in an antiseptic towel for this pur- 
pose, and kept in a closed box or drawer. 
Protection After surgical instruments have been rendered 

of surgical • i i 1 i • • 1 i 

instruments aseptic by thorough cleansing with soap and water, 

during op- . 

eration. lollowed by the process of baking, steaming, or 
boiling, they may be kept free from contamination 
during an operation by lying immersed under — 

I. Sterilized water. 
II. Beta-naphthol solution, 1-2500. 
III. Carbolic acid solution, 2 per cent, or 1-40. 

The blackening effect of carbolic acid may be 
prevented by the addition of a little glycerine to 
the solution. 

The use of iodide of mercury as an antiseptic — 
a substance used in the same manner as corrosive 
sublimate — need scarcely be mentioned. The solu- 
tions are more troublesome to prepare, and no more 
efficient, hence their use is limited. Various other 



ASEPSIS AND ANTISEPSIS. 4 1 

substances have been used for antiseptic purposes, 
but those mentioned here are the most frequently 
and universally employed. 

In the preparations of solutions of corrosive sub- 
limate, chlorinated lime, and copperas, it should be 
remembered that they have an injurious effect upon 
metal, hence should be mixed in glass, porcelain, 
or agate vessels. Large quantities of solution of 
chlorinated lime may be made in a bucket. 

These rules concerning the use of antiseptics Relation 
should be thoroughly understood by every good asepsis and 
nurse, for even the surgeons who employ aseptic 
methods, as a rule, require the use of antiseptics 
beforehand, to bring about a perfect state of asepsis 
for the operation, and to enable the aseptic state to 
be preserved after the operation. 



antisepsis. 



CHAPTER IV. 



ABDOMINAL SECTION. 



Definition. 



Abdominal 
organs. 



Pelvic or- 
gans. 



Causes for 
abdominal 
section. 



The operation of abdominal section consists in 
the making of an incision through the walls of the 
abdomen, by which the surgeon is enabled to per- 
form any operation required upon the organs con- 
tained in the abdomen or the pelvis. 

The abdominal organs are : — 
The stomach. 
The intestines. 
The liver and gall-bladder. 
The kidneys and ureters. 
The spleen. 
The pancreas. 

The pelvic organs are : — 
The uterus, or womb. 
The Fallopian tubes. 
The ovaries. 
The bladder. 
The rectum. 
All these organs are subject to disease, to inju- 
ries the result of accidents, and to the development 

42 



ABDOMINAL SECTION. 



43 



of new growths termed " tumors." Hence it may 
be seen that an abdominal section may be under- 



FlG. 2. 




Diagram Showing Abdominal Organs. 



44 



NURSING IN ABDOMINAL SURGERY. 



taken for very varied conditions. Where no actual 
disease exists, as in pregnancy, when the birth- 
track is too small, or there is some other abnormal 



Fig. 3. 




Cut Showing Vertical Section of Pelvic Organs. 

condition preventing the occurrence of labor in the 
natural way, abdominal operation may be per- 
formed to effect the act of delivery. 



ABDOMINAL SECTION. 45 

The special operation required in each case is 
known by a distinctive name. Since the nurse's 
work is closely associated with that of the surgeon, 
she will constantly hear these terms used. It is 
desirable that she should understand their meaning 
.(although it is not necessary, or even in good taste, 
for her to attempt their use), in order that she may 
make the necessary preparations in any given case 
intelligently. For the better understanding of 
these terms I append a list of the principal abdo- 
minal operations : 

Operations on the Ovaries and Fallopian Tubes : — Operations 

on internal 

I. Ovariotomy — removal of ovarian tumors. 
II. Oophorectomy — removal of ovaries of com- 
paratively small size, diseased or healthy. 
III. Removal of uterine appendages, when the 
tubes and ovaries are both removed. 

Operations on the Uterus : — 

I. Hysterectomy — removal of the uterus. 
II. Caesarean section — an incision into the uterus 
during pregnancy, for extraction of the 
child. 

III. Porro's operation — removal of the uterus, 

added to Caesarean section. 

IV. Operation for extra-uterine pregnancy, removal 

of tumor composing the ovum or Qgg } 



genital 
organs. 



4 6 



NURSING IN ABDOMINAL SURGERY. 



Operations 
on the 
stomach. 



Operations 
on intes- 
tines. 



when it is found outside of the uterine 
cavity. 
V. Abdominal section for rupture of the uterus. 

Operations on the Stomach and Intestines: — 

I. Gastrotomy — the making of an incision into 
the stomach for the removal of foreign 
bodies. 
II. Gastrostomy — the establishing of a tube-like 
passage into the stomach. 

III. Gastrorraphy — the suturing of wounds in 

the stomach. 

IV. Pylorectomy — removal of a part or the whole 

of the pylorus. 
V. Gastro-enterostomy — the formation of a pas- 
sage between the stomach and duodenum. 
VI. Duodenostomy — the operation of opening the 
duodenum, and attaching it to the abdom- 
inal wall to form an orifice for the intro- 
duction of food. 
VII. Jejunostomy — the making of an artificial 
opening through the abdominal wall into 
the jejunum, for introduction of food. 
VIII. Operation for intestinal obstruction. 
IX. Enterotomy — the making of an opening into 
the intestine. 
X. Colotomy — the making of an incision into 
the colon. 



ABDOMINAL SECTION. 47 

XL Resection of intestine — the removal of a 
portion of intestine. 
XII. Operation for artificial anus. 

Operations on Kidneys : — operations 

on kidneys. 

I. Nephrorrhaphy — the suturing of the kidney 

to the abdominal wall. 
II. Nephro-lithotomy — the operation for removal 
of stone in the kidney. 

III. Puncture of the kidney. 

IV. Nephrotomy — an operation for opening into 

the substance of the kidney. 
V. Nephrectomy — removal of the kidney. 

Operations on the Liver and Gall-Bladder : — Operations 

on liver 

I. Hepatotomy — an operation for opening into bladder." 
the liver. 
II. Cholecystotomy — an operation for opening 
into the gall-bladder. 

III. Entero - cholecystotomy — an operation in 

which, after opening into the gall-bladder 
and intestines, the two wounds are sutured 
to each other. 

IV. Cholecystectomy — removal of the gall-blad- 

der. 

Operations on the Spleen : — Operations 

x x on spleen. 

Splenectomy — removal of the spleen. 



48 NURSING IN ABDOMINAL SURGERY. 

operations Operations on the Pancreas : — 

on pancreas. 

Operation for pancreatic cysts. 

o^omenTum Operations for Tumors of the Omentum. 
and^mesen- Operations for Tumors of the Mesentery. 
Operations Cystotomy, or abdominal lithotomy — an operation 

for an incision through the abdominal wall into 

the bladder. 



on bladder. 



Although the operations mentioned are numer- 
ous, the general preparations for any case of ab- 
dominal section are so similar that they can be 
considered under one head. These will include 
the consideration of the following points : — 
I. Preparation of the room. 

II. Preparation of sponges, instruments and dress- 
ings. 

III. Preparation of the patient. 

IV. Preparation of the operator and assistants. 
V. A nurse's duty during operation. 

VI. A nurse's duty after operation and during 

convalescence. 
VII. The management of complications. 



CHAPTER V. 

THE PREPARATION OF THE ROOM. 

In speaking of the importance of obtaining for 
the patient the best possible surroundings for such 
an operation a celebrated English surgeon says : 
" There is no disputing the fact that the best results 
in abdominal surgery are got in specially prepared 

. . . . , . . The operat- 

rooms or wards. * * * * An ideal room, situated m g room. 
in an open and elevated locality, ventilated with 
warmed (and perhaps filtered) air, wall and floor 
impermeable to moisture, and readily and easily 
washed, and with many other excellences which 
could be detailed — is rarely in this country at the 
disposal of surgeons. " 

As a rule, the operation is done in the room 
which is to be occupied by the patient during the 
convalescence, unless in a special hospital where 
the rooms are conveniently arranged with reference 
to an operating room, and where suitable conven- 
iences exist for transferring patients from one room 
to another without too great risk. 

All the special preparations for aseptic work may 
be carefully arranged for, yet these cannot secure 
4 49 



50 NURSING IN ABDOMINAL SURGERY. 

the results desired, should the operator, assistants, 
or nurses fail to observe the principles of surgical 
cleanliness in every detail On the other hand, 
with a thorough understanding of these principles, 
operations of the gravest character may be per- 
formed with success in quarters the most unpromis- 
ing, and in the slums and alleys of a crowded city. 
Since " necessity knows no law," the surgical nurse 
must be prepared to convert even the filthy apart- 
ment of a tenement house into an aseptic operating 
room. To this end certain instructions regarding 
the preparation of the room should be observed. 

Dr. J. Grieg Smith tells us, " A w T ell kept bed- 
room in a home of gentle folks will require nothing 
changed or removed." Should the surgeon in 
charge of a case assume the responsibility of this 
arrangement, the nurse will, of course, observe his 
clean5ingof wishes in the matter. Should the preparation of 
the room be left to her discretion, she should re- 
gard everything in the room with suspicion until 
she has placed it beyond suspicion in the matter of 
cleanliness. The room should, if possible, be large 
and bright, facing the south, and one which can be 
kept well ventilated and yet comfortably warmed. 
There should be no stationary wash-stand in the 
room. If impossible to obtain a room without, the 
basin should have all its outlets plugged, and be 
kept filled with some antiseptic solution. 



room. 



THE PREPARATION OF THE ROOM. 5 I 

Carpets, curtains, upholstered furniture, every- Removal of 

ini 1 1 superfluous 

thing that may harbor dust and filth, ought to be furniture. 
removed. If there is any possibility of the exist- 
ence of infectious or contagious germs in the room 
it should be subjected to thorough disinfection with 
the fumes of sulphur. Before the fumes are started 
the metal fixtures in the room should be well 
greased with cosmoline, to prevent the injurious 
action of sulphur upon them. After this the room 
should be well ventilated. Should an open fire- 
place or a stove be in the room, keeping the win- 
dows open for twenty-four hours or so, while a 
large fire is kept burning in the grate, will freshen 
and purify it. 

Regarding. the use of the spray in purifying the Use of 
atmosphere we quote from Dr. Smith : * " Some 
surgeons seek to improve the purity of the atmo- 
sphere in which the operation is to be performed 
by making a steam antiseptic spray play in the 
room for a few hours. There is no strong objec- 
tion to this ; if it does nothing else it lays the dust. 
But if the room has been properly cleaned and 
ventilated, and the surrounding air is of the mod- 
erate purity and freshness that may be found almost 
anywhere in England, the spray in the room is 
perhaps uncalled for. If any objection could be 

* " Abdominal Surgery." 



52 NURSING IN ABDOMINAL SURGERY. 

raised to the proceeding I think it ought to be on 
the ground of saturating the atmosphere with 
moisture. Respiration is not so easy in an atmo- 
sphere laden with moisture as in one that is dry, 
and if a patient has to undergo a prolonged and 
dangerous operation, we should desire to have the 
recovery from shock promoted by every possible 
surrounding benefit, one of which is certainly not 
a wet, depressing atmosphere to breathe." 

Should a surgeon desire this procedure carried 
out, it may be done as follows : A shallow basin 
filled with the antiseptic solution required may be 
placed over a gas stove, the steam from which will 
rise and fill the room. Doors and windows should 
be kept closed during the process of spraying until 
the whole apartment has been thoroughly filled 
with the steam. A special apparatus known as a 
" steam atomizer" is sometimes employed, and is 
essential where during the operation it is desired 
to have the spray directed over the wound. The 
nurse will need to keep the boiler filled about two- 
thirds full of water, to renew the antiseptic solu- 
tion in the bottle from time to time, and to keep the 
alcohol lamp in good working order. 
sterilization j^q W3 \\ s as we H as the floor, should be well 

of walls, > > 

floor, etc. SW ept, and all pictures removed. If painted it is 
well to wash the walls with a corrosive jsublimate 
solution (i-iooo) or 2 per cent, carbolic acid. 



THE PREPARATION OF THE ROOM. 



53 



The floor should be washed up with this solution 
after it has been well scrubbed. But little furniture 
should be permitted to remain in the room, but this, 
with the frames of windows, doors, etc., must be 
similarly washed off with an antiseptic solution. 
Shades must be taken down, dusted and then wiped 




Steam Atomizer. 



off also with this solution. Strips of linen may be 
placed on the floor to deaden the footfalls. 

The furniture should be conveniently arranged. Arrange- 

y ° ment of 

The bed should be so placed that access may be fixture, 
had to it upon three sides, for convenience in lifting 
the patient, changing bedding, etc. Also, it should 



54 NURSING IN ABDOMINAL SURGERY. 

be so placed that the patient shall not face the light 
from the windows. It should be a single bed, 
preferably iron, and not too low, with a spring or 
woven-wire bottom, and a good horse-hair mattress. 
It is well, if possible, to have two beds, the patient 
being lifted from one bed to the other, every night 
and morning, and the bedding thus kept aired. 
This is not a necessity but a great comfort to the 
patient. A chair for the nurse and one for the 
doctor — not rockers — one or two stands, a wash- 
stand with china set, a bureau with a set of draw- 
ers, and one or two large screens, will constitute all 
that is necessary in the way of furniture. There 
should be a shade for the lamp, and a quiet-ticking 
clock placed where the nurse can see it without 
having to move too much about the room. Inside 
blinds are the best for tempering the light. There 
should, if possible, be a closet in the room, in which 
the various articles needed in the care of the 
patient may be kept. Changes of clothing, bed- 
ding, etc., may be kept in the bureau drawers. 
clothing of The clothing worn during the operation and sub- 
sequent convalescence, should consist of woolen 
or merino vest, drawers, and socks, varying in 
thickness with the season, a night-dress of special 
pattern, extending just below the shoulders in the 
back, so as to avoid unnecessary and uncomfortable 
creasing of the clothing, as the patient lies upon 



THE PREPARATION OF THE ROOM. 55 

her back, the front, pieces should extend down to 
about the knees. All the articles of dress should 
be a size larger, or even two sizes larger than those 
ordinarily worn by the patient, as they are more 
comfortable to lie in when loose. A Nightingale 
wrap of light flannel is a convenience for the pro- 
tection of the shoulders and arms. 

The preparation of the clothing, sheets, pillow steriiiza- 
cases, towels, napkins, etc., previous to operation is clothing. 
as follows : After coming from the laundry, where 
during the process of cleansing it should have been 
thoroughly boiled, it is wrung out of a solution of 
bichloride of mercury i-iooo, or carbolic acid, 2 per 
cent., when it is dried and smoothed with a warm, not 
hot, iron, or else left rough dry. Blankets should 
be either entirely new or they may be hung in a 
room or large closet, where carbolized steam is 
generated, as described above. 

Three sets of merino wear and night-dresses 
should be provided to permit the necessary chang- 
ing of clothing in case of accidents. During the 
operation it is well to have woolen stockings placed 
on the patient's feet. These are sometimes worn 
during the first week or ten days of convalescence. 

The bed-clothing is adjusted as follows: Over Arrange- 
the mattress is placed a pad for its protection, across beT-cioth- 
the middle of the bed a piece of rubber cloth a yard 
and a-half wide, pinned down securely to the edges 



56 NURSING IN ABDOMINAL SURGERY. 

of the mattress. The under sheet or a blanket is 
then spread over the entire bed, also securely 
fastened at the corners and edges by safety-pins, to 
prevent creasing. A draw-sheet (a sheet folded in 
its length until it is about a yard and a-half in 
width), is fastened across the middle of the bed, 
the closed fold of the sheet is directed upward 
toward the head of the bed to prevent the ridges, 
which more readily occur when the open end of 
the sheet is directed upward. The cover-sheet, 
blanket and spread are then adjusted. Some 
prefer the patient's lying between blankets for a 
time ; the cover-sheet in such case may be dispensed 
with. 

As the patient may vomit when coming out of 
anaesthesia it is well to protect the pillow by plac- 
ing a piece of oil-cloth or rubber around it before 
drawing on the pillow slip. A towel should be 
spread over the pillow before the patient is placed 
in bed, to protect the slip in like manner. If the 
pillow is not used, as it is often desirable to keep 
the head low, the towel may be spread over the 
upper end of the bed where the head will rest. 
Muffling of The stands should have clean cover-slips upon 

turniture. * *■ 

them. The feet of chairs, stands, or any movable 
furniture in the room should be muffled by twisting 
with a piece of roller-bandage or soft muslin, so 
that they may be moved noiselessly; or rubber 



THE PREPARATION OF THE ROOM. 57 

mufflers may be obtained at large rubber stores for 
the same purpose. Care should have been exer- 
cised beforehand to see that door hinges, latches 
and window frames, etc., are in proper order, so that 
there may be no unnecessary rattling or creaking 
produced by them. It is so essential to keep the 
patient free from irritation that all these little points 
should be carefully considered. 

A list of the principal articles needed in prepar- Articles 
ation for the operation will be as follows : — o P emion°. r 

I strong kitchen table for the patient's body. 

1 small table for patient's head. 

1 quiet-ticking clock. 

Rubber bags for hot water, metal foot-warmers, 
or soap-stone slabs or bricks for the application of 
dry heat. 

2 basins for catching fluid. 

2 large basins or new foot-tubs for sponges. 

2 flat trays, metal or hard rubber, for instruments ; 
basins may be used, though not as convenient. 

2 basins for the doctor's hands, to be used inter- 
changeably during operation. 

2 waste buckets, large size. 

2 buckets cold water. 
I bucket hot water. 

1 full wash-stand set. 

1 tin cup, graduated if possible. 

3 dozen old soft towels. 



58 NURSING IN ABDOMINAL SURGERY. 

I irrigator, either a Davidson hand-syringe, a 
fountain syringe, or a special contrivance consisting 
of a funnel, rubber tube, and long hard-rubber 
nozzle. 

I thermometer for testing heat of water. 

I piece floor oil-cloth for protection of floor. 

4 pieces of rubber gum-cloth, I y 2 yards square, 
one for the bed, three for the protection of patient 
during operation. 

1 piece rubber cloth for protection of pillow. 

2 pieces of new flannel, ^ yard wide, I y yards 
long, for abdominal bandage. 

2 pairs woolen hose. 

3 sets merino flannels for patient's under-wear. 

3 night-dresses. 

4 small horse-hair pillows, 8xio in., to use 
around patient for relief of pressure. 

3 new blankets. 
y 2 dozen sheets. 
I spread. 

1 or 2 mattresses, 

2 pads. 

2 large pillows, preferably of hair. 

I pin-cushion with shield and common pins. 

I set of antiseptic dressings. 

I lap absorbent cotton. 

I tray, with tumbler, feeder, teaspoon. 

I medicine glass. 



THE PREPARATION OF THE ROOM. 



59 



I clinical thermometer. 
I piece castile soap. 
I new nail brush. 

I vial bichloride tablets for cleansing the hands, 
etc. 

I pound Calvert's No. 4 carbolic acid. 
1 box of matches. 



Stand for\~T) 
cleansing\ Sr 
sponges | O 



Fig. 5. 



Nurse 




Window 



Receptacle Tor fluid [Operator 
Tinder' table extend- x 
ing Slightly beyond 
ectge . flap of opera- 
ting pad rests over it . 



Travsfvr 
Instruments 



o 



Stand with basin 
for operators hands 



Diagram showing Position, Operator, Assistant, etc., when but one 
Assistant. 



2 or 3 ruled reports. 

Pencil and paper for taking directions for after- 



management. 



Arrangement of operating table : — 

A table should be placed opposite a window, and 



6o 



NURSING IN ABDOMINAL SURGERY. 



but a few feet from it, unless in a special operating 
room where the lighting of the apartment by 
means of a sky-light may enable the table to 
occupy the centre of the space. 

Various special forms of operating tables have 
been devised and are in use in different hospitals. 

Fig. 6. 




Senior 
\Assisiani) _ 

7 Jtece/jcacle. 

y joi^ / fluid, under 
table 



Table fori patient's body 



Window 

°f 
Ward 



,OQi 



Chief T 
Nurse Assist t 



Trays- 
Operator} ^J^ 






Spray 



Pans 

for 

Sponges 



Diagram showing Position, Operator, Assistants, etc., when two 
Assistants. 

Ordinarily, however, a plain, narrow, wooden table, 
such as is used in kitchens in this country, may be 
made to serve the purpose very well. A chair may 
be placed at the foot of the table unless the table is 
longer than the patient. This will support her feet. 
If it is not high enough, a stool or cushions may 
be so adjusted as* to raise the feet and prevent ten- 



THE PREPARATION OF THE ROOM. 6 1 

sion of the abdominal walls. A better arrange- 
ment is the use of a small table, placed as in the cut, 
for the head. 

The table should be covered with a thick, folded 
blanket, or comfortable. A large piece of rubber 
cloth or table oil-cloth may be fastened across the 
middle, or better still, over the entire table, being 
fastened to its edges by tacks, to prevent slipping. 
In the Woman's Hospital a rubber army blanket 
is employed. A sheet is similarly fastened over 
this. A pillow protected by rubber is placed at the 
head of the table, and a folded blanket and sheet 
for covering the patient should be placed at the 
foot. 

If the carpet has not been removed from the 
room some protection must be used under the 
table, as a piece of floor oil-cloth, large enough to 
extend some distance around the table, or a piece 
of drugget or old carpet may be used, provided 
they are clean. 

In a case of ovariotomy, or any operation where 
great quantities of fluid will probably need to be 
drawn off, a large foot-tub should be placed be- 
neath the table for the reception of the fluid, also 
two basins, to be used interchangeably in receiving 
the fluid as it flows from the canula, and emptying 
it into the tub. 

Since the operator stands on the right side of the 



62 NURSING IN ABDOMINAL SURGERY. 

patient, the stand for his instruments should be 
placed near the foot of the table on the right side. 
Just back of the operator and a little to the right 
should be another stand or chair, upon which a 
basin of water for his hands should be placed, to 
be used during the operation. The water in this 
basin should be frequently changed by the nurse, 
a slop-jar for the soiled water, and a pitcher from 
which the basin may be replenished may stand 
beside this table. 

The assistant stands opposite the operator, on 
the left side of the patient ; therefore to his right 
and toward the head of the table should be- placed 
a small stand for holding a basin for the sponges, 
which, after being cleansed by the nurse, should be 
thrown into it in warm sterilized water. The nurse's 
stand with two large basins or small tubs filled, the 
one with cold, and the other with warm sterilized 
solution, should be placed a short distance back of 
this, so that the assistant may readily throw a 
soiled sponge into the basin containing cold water. 
The nurse then thoroughly w r ashing out the blood, 
will rinse the sponge through the warm water, and 
place it in the basin to the assistant's right. A 
slop-basin and a tin mug, a pitcher or bucket of 
warm and one of cold sterilized water should stand 
by the nurse's table, so that there may be no delay 
in changing the water. 



THE PREPARATION OF THE ROOM. 63 

A basin of water for the cleansing of her own 
hands should stand conveniently near, either on the 
stand or a chair, so that in attending to the empty- 
ing and re- filling of the basin, she may cleanse her 
own hands before again touching the sponges. 

A small, light basin should be placed under the 
pillow on the table, to be at hand should the pa- 
tient vomit. Three or four soft towels to be used 
by the etherizer may also be placed under the 
pillow. The irrigator with a pitcher or two of 
sterilized water of required temperature should be 
placed to one side, in readiness for use at any 
time. 

The window may be screened by a thin curtain 
of white muslin or lace fastened across the lower 
panes, or if necessary to protect the entire window 
from the intrusive gaze of outsiders, whiting may 
be painted over the inside of the panes, which will 
exclude observation, but admit light. 

When the operator works with two assistants 
beside the ansesthetizer the arrangement as indicated 
in Fig. 6 may be followed. 

Immediately before the operation, heated foot- 
warmers — bricks wrapped with towels or jars filled 
with hot water — should be placed in the bed, over 
the site upon which the patient is to lie, and under 
the covers, so that the bed may be warm for her 
reception. 



6 4 



NURSING IN ABDOMINAL SURGERY. 



A basin containing a block of ice and one or two 
soft towels may stand near the etherizer, as the 
application of cold to the head during etherization 
aids frequently in controlling nausea and diminish- 
ing the subsequent headache. 

Fig 7. 




Glass Graduate with Thermometer. 



The restoratives which may be needed should 
the patient sink into collapse should be near at 
hand — brandy, digitalis, aromatic spirit of ammonia, 
etc., as the surgeon may desire. A hypodermic 
syringe in good condition for immediate use should 
also be provided. 



THE PREPARATION OF THE ROOM. 65 

The irrigator or syringe to be used in washing 
out the abdominal cavity, and sterilized water should 
be kept in readiness for use when called for. 
Special receptacles for hot and cold sterilized water 
may be provided, or a large pitcher full of each, 
covered with towels to prevent contamination with 
dust, may be set to one side for the purpose. 
Another pitcher with distilled water at the required 
temperature (from io5°-iio° Fahr.) should be kept 
in constant readiness, so that no time may be lost 
in preparing it. 

A bath thermometer, kept in the pitcher, enables 
the nurse to watch the temperature of the water, 
and to make an addition to it from time to time 
from the pitcher of hot water, so as to have it just 
right when wanted. A large glass graduate with 
thermometer attachment is used for the purpose in 
some hospitals. 

The Davidson hand-ball syringe used as a siphon 
will serve as an irrigator where no especial apparatus 
has been provided. The long rubber vaginal nozzle 
will need to be used, rather than the shorter nozzles. 
This syringe and the nozzles should, of course, be 
perfectly new when used for the purpose. 

A representation of a very simple yet efficient 
irrigator is shown in the cut. 

A good plan, where considerable water is likely 
to be needed for irrigation, is to have three or four 
5 



66 



NURSING IN ABDOMINAL SURGERY. 



pitchers of water of the required temperature ready, 
so that they can be used in quick succession, or a 
large glass vessel placed on a shelf, or hung some 



Fig. 8. 




Apparatus for Irrigation of Abdominal Cavity. 

distance above the patient, may have the rubber 
tubing and nozzle attached, and may be kept filled 
with water of the temperature required. 



CHAPTER VI. 

PREPARATION OF SPONGES. 

The nurse should know something of the nature Desmp- 
ot sponges, in order to appreciate the necessity for sponges. 
a thorough cleansing of them prior to their appli- 
cation to surgical uses. The sponge. is an animal 
found in the various seas, the fresh water forms 
being found in rivers and lakes. What we call a 
sponge is the skeleton of the animal. There are 
various species of sponges, some being much finer 
and softer than others. The latter are especially 
well adapted for use in delicate surgical work. 
These come to us largely from Turkey and are whence 
called the Levant sponge. The Dalmatian sponge 
is also a fine sponge. A similar species, though 
not quite so fine, is obtained from the Mediterran- 
ean. Two other species, the horse sponge and 
Zimocca sponge, of coarser quality, are also ob- 
tained from the Mediterranean. Florida sponges 
have of late grown much in favor, and are of a 
variety of species, some of which are very fine. 
Sponges grow at varying depths beneath the water, 
fastening themselves to rocks, stones, and other 

6 7 



68 



NURSING IN ABDOMINAL SURGERY. 



Diseased 

sponges. 



Methods of objects. The methods for obtaining: them are by 

collecting ... . 

and pre- harpooning, diving, and dredging. After they are 
the market, taken from the water they are exposed to the air 
for some hours until they show a tendency to de- 
composition. They are then beaten with a thick 
stick, or trodden by the feet in a stream of flowing 
water, until the skin and outer soft tissues are com- 
pletely removed. 

After this cleansing they are hung up in the air 
to dry and then pressed into bales. If the sponges 
are packed before they are thoroughly dry a dis- 
ease, shown by the presence of orange-yellow spots, 
breaks out among them. This is called the 
" sponge cholera," or "pest." Some sponges are 
naturally of a dark brownish red near the base. 
This must be distinguished from the disease spots. 
In wholesale houses for selling sponges they are 
cut in shape and further cleaned. The light- 
colored sponges seen in drug stores have been 
bleached by the use of chemicals. Sponges are 
sold by weight, hence sand is often used as an 
adulteration. 

For hospital use sponges may be bought in 
25 lb. bales, bleached and purified. When thus 
&* hospital obtained and prepared they probably cost about 
Y^ cent each when ready for use. For private 
operations the surgeon usually provides his own 
sponges and attends to their preparation. 



The pre- 
paration of 
sponges in 
quantity. 



PREPARATION OF SPONGES. 69 

The methods for cleansing sponges, as obtained 
by the bale, is as follows : — 



FOR CLEANING NEW SPONGES. 

Method No. 1. — They must first -be pounded in Methods 

for cleaning 

an iron mortar, or upon a flat stone, to break up andrender- 

L L ing aseptic 

any particles of sand they may hold. Should they new 



be very sandy it is well to soak them in a solution 
of muriatic acid (2 drachms to the pint) fdr a few 
hours. Wring them out in several clean, filtered 
waters until the water remains perfectly clear. 
Then immerse in a saturated solution of perman- 
ganate of potassium for an hour. After bleaching 
them with a ten per cent, solution of sulphurous 
acid (which does its work in an instant), again 
wring them out in several clean, filtered, and steril- 
ized waters until the water remains perfectly clear 
and transparent. 

Method No. 2. — After ridding the sponges of 
their sand according to the method described, 
wring them out of several clean waters. Then im- 
merse in a saturated solution of permanganate of 
potassium for an hour. Next put them into a 
saturated solution of oxalic acid and let them 
remain in this until bleached. They must then be 
rinsed in several waters (the water being filtered 
and boiled) until the water is perfectly clear. 



sponges. 



7° 



NURSING IN ABDOMINAL SURGERY. 



Method for 
cleansing 
old 
sponges. 



Discolora- 
tion of 
sponges. 



Storing 
sponges. 



Prepara- 
tion for 
operation. 



TO CLEANSE OLD SPONGES. 

After washing them in cold water to remove the 
blood, let them soak from 10 to 12 hours in a satur- 
ated solution of baking soda, to free them com- 
pletely of animal matter. Rinse in several waters, 
and immerse for an hour in the saturated solution 
of permanganate of potassium. After bleaching 
them with a saturated solution of oxalic acid, rinse 
them in several clean waters (boiled and filtered) 
until the water is clear. 

Of the methods described the first produces the 
prettiest sponges, as the bleaching process is more 
complete with the sulphurous than with the oxalic 
acid. Should the sponges during an operation get 
into a bichloride of mercury solution,' it will be 
found that in recleansing them the sulphurous acid 
cannot be used, a chemical reaction causing a dark- 
ening of the sponge, so that, although clean, it 
looks unfit for use. 

After cleaning, sponges may be stored until 
needed in tightly covered glass jars, being im- 
mersed either in alcohol or in a solution of carbolic 
acid 1-40. 

Before operation the sponges thus stored should 
be thoroughly rinsed out in sterilized water and 
placed in a basin containing warm sterilized water 
until wanted. 

The number of sponges to be used during oper- 



PREPARATION OF SPONGES. 7 1 

ation should be carefully counted and recorded on Jjjgj^ * 
a piece of paper, placed in some conspicuous place j^ s n ^ 
for the operator to see. An addition should ^^011. 
never be made to the number of sponges in use 
during an operation without a corresponding change 
in the number marked on the paper. A sponge 
should never be cut in two without a similar pre- 
caution, as this will change the count, and a sponge 
may thus be lost sight of and allowed to remain in 
the abdomen. 

When the operator is ready to close the abdomen Counting of 

* y sponges. 

all the sponges should be counted by the nurse in 
a clear, loud tone, so that he may be assured that 
all are accounted for. 

The assistant, as a rule, takes the sponges out of 
the warm water and squeezes them dry as he de- 
sires them. Should this office devolve upon the 
nurse, she should see that they are well freed from 
moisture, and that they are warm when handed to 
the surgeon. 

Sponges which are to be carried down into the Mounted 

sponges. 

abdomen for cleansing it should be mounted on 
rods called sponge-holders. Three or four of these 
should be in readiness. They will be needed at the 
close of the operation and must be handed in rapid 
succession as wanted. When thus placed in hold- 
ers or forceps they are called " mounted sponges." 

Flat sponges are used for protecting the intes- f^nges. 



J2 NURSING IN ABDOMINAL SURGERY. 

tines, or for application of heat to the abdominal 
wall. It is well to keep these flat sponges in a 
separate basin of hot water, handing them when 
needed. Large squares of flannel wrung out of hot 
water are sometimes used in place of sponges for 
application of heat to the abdomen, or for covering 
over coils of intestine or omentum that may be 
drawn out of the wound during the course of an 
operation. 
Artificial Artificial sponges are made by enclosing balls of 

sponges. ± o j o 

sterilized absorbent cotton in sterilized gauze, fasten- 
ing this firmly with a few stitches so as to perfectly 
enclose the cotton. These balls may be made of 
varying sizes. They are used but the once and are 
thrown away or burned after the operation. They 
are largely used in place of the natural sponge in 
many of the hospitals in this country, hence the 
nurse should learn how to prepare them. She may 
also thus learn how to improvise sponges for use 
in a private house, in case of any emergency which 
may require them. 



CHAPTER VII. 

STERILIZATION OF INSTRUMENTS, ETC. 

The nurse receives the instruments from the 
surgeon and subjects them to a process of steril- 
ization by wrapping them in a clean dry towel and 
laying them in a dry or a steam sterilizer, according 
to the operator's wish. 

If dry sterilization is used, the temperature will Dry sterUi- 

zation. 

require to be at least as high as no C, or 230 
Fahr. 

In the steam sterilizer a temperature of ioo°- steam- 

. steriliza- 

105 C, corresponding to 212-221 Fahr., is suf- tion. 
ficient. The rule in most hospitals is to keep the 
instruments in the sterilizer for about one hour, 
immediately preceding operation. At the time of 
the operation the instruments may be lifted out, and 
the towel around them being loosened they may 
be allowed to slip into sterilized trays containing 
warm sterilized water. The nurse's or assistant's 
hands should be thoroughly disinfected before this 
is done. 

The method of sterilizing the dishes or trays steriiiza- 

1-1 • 1 • • r 11 tionof 

which are to contain the instruments, is as follows : instrument 

trays. 

73 



74 



NURSING IN ABDOMINAL SURGERY. 



Immersion 
of instru- 
ments in 
antiseptic 
solution. 



They should first receive a thorough cleansing with 
soap and warm water, and then should be filled 
with some strong antiseptic solution, as 1-500 or 
1-1000 bichloride of mercury — if of rubber or 
porcelain ; if metal, a solution of carbolic acid 
1-20, or of beta-naphthol 1-2500 should be used. 



Fig. 




Arnold Steam Sterilizer. 



This may stand in the trays until they are needed 
for the instruments, when the antiseptic solution 
being emptied out is replaced by boiled distilled, 
or filtered water. The trays should be about half 
full, so that the instruments may be well covered. 



STERILIZATION OF INSTRUMENTS, ETC. 75 

All the towels and sheets in use around the pa- sterfliza- 
tient should be sterilized. Having been carefully towels, 
laundried, they should be placed in the steam 
sterilizer for an hour preceding the operation, from 
which they can be removed as required for the use 
of the surgeons. In some hospitals they are steril- 
ized in quantity and stored in glass jars containing 
3 percent, carbolic solution. 

When steam sterilization or dry sterilization Process of 

J sterilizing 

cannot be effected for want of means, the towels, b >;H se ° f 

, » antiseptics. 

etc., after a thorough boiling may be soaked in a 
solution of bichloride of mercury I-IOOO, or 
carbolic acid 1-20, and carefully dried in an oven 
or clean drying-chamber. After this they should 
be kept free from dust in large glass receptacles or 
closed boxes, or they may be stored in a carbolic 
acid solution. 

The sterilization of cheese-cloth or gauze, and p rep ara- 
the preparation of bichloride gauze has already antiseptic 

dressings. 

been given in detail in the chapter on Asepsis and 
Antisepsis. The same formula may be followed 
in the preparation of carbolized gauze, borated 
gauze, etc. The strength of the solution of the 
special substance to be used in each case will be 
given the nurse by the surgeon, should he require 
her to prepare the dressings. As a rule the strength 
of the solution used in the preparation of the gauze 



7 6 



NURSING IN ABDOMINAL SURGERY. 



Iodoform 
gauze. 



Provision 
against 
contamina- 
tion of anti- 
septic 
dressings. 



is the same as the strongest solution of the agent 
as employed in irrigation. 

The formula for iodoform gauze is somewhat 
different. Methods for preparing it vary somewhat, 
but the following has been found very satisfactory : 
Six ounces of a I per cent, solution of carbolic 
acid and sterilized water should be prepared, to 
which is added sufficient castile soap to make a sud. 
Twelve drachms of iodoform powder should be 
thoroughly mixed with this. Three yards of gauze 
previously sterilized by steaming, baking, or boil- 
ing, may be prepared by saturating with this mix- 
ture. A basin, graduate, and glass rod, which have 
been previously sterilized, should be used in the 
making of the mixture and the preparation of the 
gauze. The same rule should be observed in dry- 
ing this gauze in the oven as before stated, that is, 
that a little glycerine should be sprinkled over it to 
prevent its becoming non-absorbent. The gauze 
may be cut and preserved in glass jars while moist. 

In cutting gauze into strips of the desired length, 
care should be taken not to contaminate it. A 
sterilized towel may be spread over a piece of 
rubber cloth w r hich has previously been cleaned 
with some antiseptic solution; the gauze maybe 
laid down upon it and cut into the desired strips 
with a pair of sterilized scissors. The hands of 



STERILIZATION OF INSTRUMENTS, ETC. JJ 

the nurse should be thoroughly disinfected prior to 

the operation of cutting the gauze. Strips of sizes of 

. . strips. 

gauze 6 to 8 inches long and 4 inches wide are of 
good size ; also pieces of gauze 4 inches square, 
some of which are folded so as to make triangles. 
These are especially nice for tucking around a 
drainage tube or serre-noeud. A large pad of 
several folds of gauze, or a pad of sterilized absor- 
bent cotton enclosed in gauze, and large enough 
to cover the whole abdomen should be in readiness. 
To prevent handling the dressings, the strips of storing of 

. . . , antiseptic 

antiseptic gauze may be preserved in glass oint- dressings. 
ment jars of large size with glass lids, such as 
are used in drug stores. The nurse can then 
simply remove the lid and hold the jar near the 
surgeon, enabling him to help himself to the pieces 
as he needs them. 

A many-tailed bandage of new flannel and a pin- M .W: 

J & r tailed ban- 

CUshion with safety pins will be necessary. da s e - 

The bandage, with the pad and strips of gauze Special 

dressings. 

and a piece of rubber dam about 16 inches square 
(also sterilized by soaking in carbolic or bichloride 
solution), with a sponge or sterilized cotton to be 
placed over the drainage tube, should be wrapped 
in a sterilized towel and placed to one side until 
needed, when the nurse should bring them to the 
operator. If a drying powder, such as boric acid D r ^ n e ? s 
or iodoform, or the two combined, is used it is best 



78 NURSING IN ABDOMINAL SURGERY. 

kept in a pepper-box or a small box with a piece of 
gauze tied over the top, so that the powder may be 
dusted on to the wound. 
Method of The bandage should consist of a piece of new 

making ° L 

[atiedban- °P era flannel (canton flannel or even thick muslin 
dage. can k e usec j) # This should be properly shrunken. 

A piece sufficient for one bandage should be 
about y± yard wide and ij^.-i}4 yards long. 
The sides should be torn toward the centre into five 
strips of equal width. A square of unbleached or 
any firm muslin, large enough to extend well 
beyond each side of the patient's loins, as she lies 
upon the bed, may be used as the base on which 
the middle portion of each one of five separate 
strips of flannel may be sewed. The strips should 
be closely basted on, each overlapping the preced- 
ing strip about y^ of its width. The muslin may 
be turned over the edges of the highest and lowest 
strip. The square of muslin and the strips should 
be whipped with cotton at the edges and not 
hemmed, as this makes an uneven surface to lie on. 
The bandage should be made longer or shorter 
according to the size of the patient. The object 
of the muslin square is to prevent the disagreeable 
sensation of flannel next the skin, particularly as 
in lying upon it the back is apt to become much 
heated. 

In putting this bandage on, it should be so 



STERILIZATION OF INSTRUMENTS, ETC. 79 

arranged that each succeeding strip overlaps the one A PP iica- 
already adjusted, starting from the upper part of bandage. 
the abdomen. Some surgeons use a perineal pad Thepen- 

* x neal pad. 

in addition to the abdominal dressing. In that case 
a pad of sterilized gauze or cotton may be applied 
over the vulva and held in place by means of 
a napkin or towel fastened to the lower border 
of the abdominal bandage, both anteriorly and pos- 
teriorly. 

A word or two further may be said in this con- Rubber- 
dressing. 

nection concerning the india rubber cloth used for 
protection of the drainage tube. A piece about 
one foot and a half square is necessary. A very 
small hole is cut in the centre of the cloth. The 
edge of the hole in the cloth is slipped over the rim 
of the tube and grips the neck of the tube. If 
properly put on this rubber cloth will catch any 
fluid which may escape in such quantity as to soak 
through the sponge or dressing placed over the 
mouth of the tube. At each dressing the nurse 
has simply to turn down the covers of this cloth, 
which had been folded over the tube and pinned. 
The tube is thus made accessible. The sponge, Protective 

1 ° sponge. 

when used to cover the orifice of the tube, should 
be a small conical sponge. During the drainage 
of the tube this sponge should be kept in an anti- 
septic solution until it is again needed. 

In hospital practice particularly it frequently de- 



80 NURSING IN ABDOMINAL SURGERY. 

Ligatures volves upon the nurse to prepare, or assist in pre- 

and sutures. L x x x 

paring, the ligatures and sutures. 

Ligatures are strands of silk or cat-gut, etc., used 
in tying bleeding vessels, or separating tumors, 
diseased organs, etc., from the tissues to which they 
are adherent. 

Sutures are strands of various materials, silver 
wire, iron wire, silk, silk-worm gut, cat-gut, etc., used 
in approximating the edges of w T ounds. 
Quality of The s j[k use d in abdominal surgery is generally 
the best quality of " Surgeon's Cable Twist." Three 
sizes are usually required : fine for the superficial 
sutures ; medium, or intermediate, for the deep 
sutures; and heavy for pedicles. This is the best 
silk for minor operations as well. 
Cat-gut. Cat-gut comes in similar sizes, and is required in 

the three kinds for the same purposes, if the surgeon 
prefers its use to silk. 

These should be wound on separate glass reels 
for sterilization before use. 

The reels containing silk should be put into glass 
tubes, like test-tubes, containing a wad of cotton in 
the bottom. The mouth of the tube should be 
plugged with cotton. The tubes may then be 
placed in a steam sterilizer or sterilizing oven for 
a time on three successive days — for one hour the 
first day ; *4 hour on the second and third days. 
It is said that thus sterilized it will keep indefinitely. 



Steriliza- 
tion of silk 



STERILIZATION OF INSTRUMENTS, ETC. 8 1 

This method, as well as the following for the 
preparation of cat-gut, is employed by the surgeons 
in Johns Hopkins Hospital. 

Soak the cat-gut in bichloride of mercury solu- Prepara- 

° J tion of cat- 

tion 1-1000 for one hour, then in absolute alcohol s ut - 
one hour. Following this, soak for 48 hours in oil 
of juniper and wind on glass reels. For y 2 hour 
before use the reels of cat-gut may be placed in a 
jar containing alcohol and boiled in a water-bath. 

Ligatures should be cut both of silk and cat-gut, 
bunched and wound together, and placed in tubes 
for sterilization. Care must be taken to observe 
the different methods in sterilization of silk and cat- 
gut. 

Tubes should be prepared containing only one J re P a j a : 

r r o J tion of liga- 

size of ligatures. When sutures or ligatures are tures - 
wanted from a tube, the quantity needed may be 
removed and the tube replugged. The length of 
ligatures will vary with the requirements. Short 
ligatures of fine silk or cat-gut, 6-8 inches in length, 
are used for tying superficial vessels. A medium 
thickness will be needed for deeper and larger ves- 
sels, and the thickest strands for ligating the pedi- 
cles of tumors, etc. The latter ligatures will need 
to be from 40 to 50 inches long, as the pedicle must 
frequently be divided and the ligatures used to en- 
close considerable tissue. 

Silk-worm gut and silver wire may be cut in 
6 



82 



NURSING IN ABDOMINAL SURGERY. 



Steriliza- 
tion of silk- 
worm gut 
and silver 
wire. 



" Ignition 
tubes." 



proper lengths, 8-10 inches, and bunched together 
and doubled into test-tubes for sterilization, accord- 
ing to the same process as silk. 

The glass-tubes used for this purpose, which 
have recently been devised, have been called " igni- 



Fig. 10. 










Ignition Tube containing Glass Reels wound with Silk, etc. 



tion tubes/' and have the advantage over ordinary- 
test-tubes in their greater durability. 
capillary 1 " Should capillary drainage be employed the nurse 
nage ' will need to prepare pieces of gauze cut into nar- 



FlG. II. 




Ignition Tubes for Sterilizing Ligatures, etc., containing Glass Reels. 



row strips in suitable lengths for drainage tubes. 
These should be sterilized in ignition tubes, simi- 
larly plugged and used as required in the changing 
of the dressing. 



STERILIZATION OF INSTRUMENTS, ETC. 83 

A sufficient supply of sterilized dressings, gauze, 
cotton, etc., and another bandage should be kept 
in readiness for changes subsequent to the opera- 
tion. These should be carefully guarded from all 
contamination, hence should be wrapped in a steril- 
ized towel and kept in a closed box or drawer, or, 
if possible, in closed glass jars. 

The threading of needles for the operation some- Threading 

. T , of needles. 

times devolves upon the nurse. In that case a 
tray with the needles already threaded and the 
ligatures and reels of sutures properly arranged 
should be in readiness for the surgeon. Long 
straight glovers' needles are those ordinarily used 
in abdominal section for the deep stitches. If the 
surgeon desires, these should be threaded at both 
ends. Four or five sets of these sutures at least 
should be prepared, as there is often considerable 
delay in rethreading. For the superficial stitches 
a smaller glover's needle with fine suture will be 
required. Curved needles may be preferred by 
some operators. The large needles are frequently 
used without being placed in a needle-holder. The 
smaller ones the nurse should place in the holder 
before she hands them to the physician. In seizing Method of 

seizing 

the needle in the holder care should be taken not needle in 

holder. 

to grasp it directly over the eye, but just beyond 
it, as the eye is apt to split from the pressure. 
The silk and cat-gut may be carried through the 



Carriers. 



8 4 



NURSING IN ABDOMINAL SURGERY. 



eye, and occasionally silk-worm gut and wire are 
also thus threaded. In the latter case the strand 
should be carried but a short distance through and 
bent into a sharp angle at the point where it passes 
through, so that it may not catch on the tissues in 
passing through them. Silk-worm gut and wire 
are usually drawn through the tissues by the aid 
of strands or loops of fine silk, called " carriers," 
into which the angle, made in the bent silk-worm 
gut or wire, may be hooked. The loop is made 



Fig. 12. 




Needle-holder. 



Pedicle 
ligatures. 



by passing the ends of the silk through the eye on 
the same side of the needle, crossing them and 
tying around the needle in a small knot. 

Ligatures for the pedicle are threaded into an 
instrument with an eye at the point, called " a 
pedicle needle." The operator usually has two or 
three of these. The long ends of the silk should 
be twisted around the instrument to prevent tang- 
ling, until the ligature is needed. 



STERILIZATION OF INSTRUMENTS, ETC. 85 

A list of the instruments most commonly em- 
ployed for abdominal operations is as follows : — 
Scalpel. 

Fig. 13. 




Scalpels. 

Knife. 

Haemostatic, or pressure forceps. 



Fig. 14. 




Pressure- forceps. 



Grooved director. 



Fig. 15. 




Grooved Director. 



86 NURSING IN ABDOMINAL SURGERY. 

Scissors (curved, straight, or angular). 

Fig. 16. 




Trocar. 



Curved and Bent Scissors. 



Fig. 17. 




Volsella. 



Trocar and Canula. 



Fig. 18. 




Volsella. 



STERILIZATION OF INSTRUMENTS, ETC. 87 

Cyst forceps, or large pressure forceps, straight. 



Fig. 19. 




Cyst Forceps. 



Bent pressure forceps. 



« a 



Fig. 20. 




T Forceps. 



88 NURSING IN ABDOMINAL SURGERY. 

Retractors. 



Fig. 21. 




Retractor. 



Pedicle needle. 
Needle-holder (see Fig. 12). 



Fig. 22. 




Serre-nceud. 



Pedicle Needle. 



Fig. 23. 




Serre-noeud. 



STERILIZATION OF INSTRUMENTS, ETC. 89 

Pedicle pins. 



Fig. 24. 



Pedicle Pins. 
Drainage tube. 
Syringe for draining tube. 
Needles. 



CHAPTER VIII. 

PREPARATION OF THE PATIENT. 

forprevSus I* * s we H> if possible, to have the patient under 

Son^ ara " observation some days before operation, in order 
that she may have a thorough physical examina- 
tion, and also that the functions of skin, kidneys 
and bowels may be stimulated to their proper 
activity, if they have, as is so often the case, been 
sluggish from improper habits of living. 

Daily bath. If the patient is in fair condition a daily warm 
bath, with a thorough cleansing of the skin with 
soap and water, will be of advantage. On the day 
of the operation particular care will have to be 
taken in the cleansing of the site of the operation. 
This process will be described later. 

Daily vagi- ^ daily vaginal injection of some antiseptic solu- 

nal injec- y fc> J sr 

tion - tion is desirable. 

Daily A daily evacuation of the bowels should be ob- 

evacuation ' 

of bowels, tained by careful regulation of the diet, or, if neces- 
sary, by the use of laxatives and enemata as pre- 
scribed by the surgeon. 

character The meals should be of such character as to leave 

of food. 

as little residual matter in the bowels as possible. 

90 



before 
operation. 



PREPARATION OF THE PATIENT. 9 1 

Hence broths, milk, eggs, etc., should constitute a 
large proportion of the dietary. The patient should 
be well fed, but a careful selection of the articles 
for her meals should be made. 

The day before the operation it is well to employ t ^ p * f ra ~ 
a purge — one of the salines is usually employed for ^dflteiy" 
the purpose, as a tablespoonful of Rochelle or Ep- 
som salts by mouth; or the surgeon may prefer the 
use of a saline by enema. 

A combination frequently used by us is the fol- 
lowing : — 

2 tablespoonfuls of Rochelle or Epsom salts. 
2 " " Castor oil. 

1 " " Turpentine. 

1 " " Glycerine. 

1 pint of water (105 F.). 

These should be thoroughly mixed and carefully 
injected into the boweL As a rule the bowels act 
freely within a short time after this injection has 
been received. To prevent any possible irritation 
of the bowel a small quantity, as I gill of saline 
solution {y 2 teaspoonful of salt to I gill water), may 
be injected into the bowel and retained after a free 
evacuation has been obtained. Should the salts be 
given by mouth the evening before an operation, a 
simple enema of soapsuds on the following morn- 
ing will be sufficient to produce a satisfactory 
evacuation. 



9 2 



NURSING IN ABDOMINAL SURGERY. 



Special pre- 
parations 
on day of 
operation. 



On the morning of the operation a full bath 
should be given — a plunge bath of soap and warm 
water, if the patient is strong enough. If not, a 
sponge-bath may be given as the patient lies in bed. 

The abdomen should be shaved of all hair, par- 
ticularly the pubes. It is well to ask the surgeon 
whether he desires this done or not, as some sur- 




Aseptic Razor with Metal Handle. 



Cleansing 
of site of 
operation. 



geons prefer doing it after etherization, if done at 
all. 

Cleanse the abdomen of all grease by rubbing 
over it a little turpentine, alcohol, or ether. This 
should be followed by again washing with warm 
water and subsequently with the antiseptic solu- 
tion 1-1000 bichloride of mercury. After this a 



PREPARATION OF THE PATIENT. 93 

dressing, wet or dry, of some antiseptic gauze 
should be bandaged over the part and kept in 
place until it is time for the operation. In this 
cleansing the umbilicus and pubes should be espe- 
cially well scrubbed with a nail brush ; all particles 
of dust and dirt should be gotten rid of. 

The patient's hair should be arranged in two menTof" 
braids, one immediately behind each ear, the hair hair- 
being parted all the way down the back. This 
gives the patient a smooth surface to lie on, and 
prevents the matting of the hair, which is so apt to 
occur with any long-continued illness. 

Earrings should be removed, as they may catch f£™° y f of 
in the clothing, and, if the patient struggles while ^f 6 teeth ' 
taking ether, the ear may be torn. False teeth 
should be removed, whether whole sets or single 
teeth, as they may be swallowed during etheriza- 
tion. They should be put away in a safe place. It 
is best to keep them immersed in a little fresh 
water. 

The patient should have on an entirely fresh suit clothing of 

patient. 

of clothing, a merino undervest opened all the way 
down the front and brought together by tapes fast- 
ened two or three inches back from the edges, so 
that no gap may be left between when the tapes 
are tied. Merino drawers and woolen stockings 
should be worn and a night gown of especial pat- 
tern, having a short back-piece which reaches just 



94 NURSING IN ABDOMINAL SURGERY. 

below the shoulders, the front of the gown being 
long enough to reach to the knees. This avoids 
the thick folds and creases under the patient's back 
which the ordinary long night gown is so apt to 
produce. 

At least three suits of clothing should be pre- 
pared to have sufficient for the changes that may 
be necessary. The clothing should be of a size 
larger or two sizes larger than that ordinarily worn 
by the patient, as loose clothing is so much more 
comfortable to lie in. 

^bladder 11 The patient should pass water before operation, 
so that the full bladder shall not be in the way of 
the operator. If there is some abnormal condition 
which prevents her passing water, the catheter may 
have to be passed. But this is best done after 
etherization, both because it gives the patient less 
annoyance and because it is desirable to accurately 
locate the bladder at the time of operation. 

Antiseptic A vaginal injection of bichloride of mercury i- 

vaginal ° J J 

injection. 4000, should be given just before the operation. 
Occasionally the operator prefers to have it given 
after the patient is placed upon the operating table. 

These preparations should be made in some 
other than the operating room, and the patient, 
after she is ready, may lie down on a bed between 
sterilized sheets until she is etherized. 

The patient should take no food on the morning 



PREPARATION OF THE PATIENT. 95 

of the operation. If the operation is not to take Abstinence 
place until noon or later, a cup of hot coffee or tea, 
according to her choice, may be given her. Milk 
should be avoided because of its tendency to form 
curds (especially under the effect of strong nervous 
excitement), which may remain in the stomach, and 
being vomited during etherization tend to choke 
the patient. The patient should remain in bed on 
the morning of the operation, to avoid feeling 
faint for want of food. 

Coverings. — During the operation the patient 
should be so wrapped that as little as possible of 
the body heat shall be lost. 

A warm blanket may be folded over the lower Arrange- 

* ment of 

limbs, or wrapped around them and fastened with clothing 

7 L x prepara- 

safety pins, if it is desired thus to keep the limbs ^y^ 

* * ' i operation. 

immovable. If the surgeon desires to be able to 
separate them or bend them from time to time, they 
may be separately wrapped and pinned in blankets. 
The clothing of the chest should be folded back, 
being drawn above the shoulder-blades and on a 
level with the breasts, and thus fastened with safety 
pins. The sleeves may similarly be rolled up above 
the elbows, sterilized towels being twisted around 
the uncovered portion of the arm, the end of the 
twist at the wrist being tucked under the patient's 
body as the arms are stretched out at her sides. A 



tives. 



96 NURSING IN ABDOMINAL SURGERY. 

different disposition of the arms will be required if 
the operating pad is used. They may in the latter 
case be bent at the elbow, the fore-arms resting 
upon the pillow and covered by the clothing of 
the chest. A blanket or a piece of flannel may be 
placed over the patient's chest, or a layer of cotton 
wool may be put under the merino vest. If it is 
necessary to take extra care about keeping the 
patient warm, a rubber bag filled with hot water 
may be placed at her feet, or rolls of wool wrapped 
around the limbs under the blankets. 
Protec- Different surgeons have various devices for pro- 

tecting the patient's clothing during operation. 
Special pads of rubber may be adjusted under the 
patient's back and thighs, which will serve to carry 
off the water used in irrigation or any liquid 
spilled. A very simple and effectual arrangement 
is that afforded by three sheets of rubber protec- 
tive, each 1 y 2 yards wide and 2 yards long. One 
of these may be slipped under the patient's back, 
covering the arms at the side, the ends hanging 
down over tHb sides of the table. Another is so 
adjusted as to cover the chest, being folded under 
the clothing front and back. 

Towels may be so arranged in covering the rub- 
ber that it does not come in direct contact with the 
skin. The third piece of rubber sheeting covers 



PREPARATION OF THE PATIENT. 



97 



the blanket over the lower limbs, being turned 
down over the edge of the blanket on a line with 
the pubes. A sterilized sheet may be spread over 
this rubber sheet and similarly turned down. 
Sterilized towels may then be placed on the chest, 
over the sheet covering the lower limbs ; also, 



Fig. 26. 



F/G.2 



\5£3.X.fe,^Ki*& 




Arrangement of Operating Pad in Abdominal Section. 



covering the rubber cloth at the sides of the patient. 
The dressings applied over the abdomen should 
not be removed until the operator is ready to pro- 
ceed to his work. 

Some operators prefer retaining a catheter in 
7 



98 NURSING IN ABDOMINAL SURGERY. 

Retention the bladder as a guide during the operation. In this 
in bladder, case a shallow urinal or ordinary soap-dish may be 
slipped between the limbs to catch the urine as it 
flows out. 

All this adjustment of clothing, protectees, etc., 
can be made in a very few minutes after etheriza- 
tion is complete. 



CHAPTER IX. 

PREPARATION OF OPERATOR AND ASSISTANTS. 

The operator, his assistants, and nurses should be 
thoroughly prepared for the grave work they are 
to undertake by especial attention to personal personal 
cleanliness. A full bath with an entirely fresh suit of c ean mei 
clothing, as described in the chapter on the Surgical 
Nurse, will be sufficient so far as concerns the 
general preparation of the person. The hands and 
arms will need further attention for their especial 
sterilization. The method which originated, I Methods of 

° cleansing 

believe, in the Johns Hopkins Hospital and has !^ sand 
since been employed in other institutions, has 
been found very satisfactory. The hands and 
fore-arms being thoroughly scrubbed with soap 
and warm water for several minutes, the finger- 
nails having previously been carefully cleaned 
and cut, the hands are immersed for about one 
minute in a saturated solution of permanganate of 
potassium, which is well rubbed into the skin. 
The hands are then bleached in a saturated solution 
of oxalic acid. The oxalic acid solution is then 
washed off with distilled boiled water and the 

99 



100 NURSING IN ABDOMINAL SURGERY. 

hands finally immersed in a solution of bichloride 
of mercury from i-iooo to 1-5000 for about one 
minute. It is claimed by the originators of this 
method that cultures taken from beneath the finger- 
nails of hands thus cleaned have been found to be 
absolutely sterile. 

The staining effect of permanganate of potas- 
sium, which remains to some extent even after the 
use of oxalic acid, if the hands be thus frequently 
cleansed, is the chief objection to this method. It 
is well probably to employ it, should one be 
obliged to operate shortly after the handling of 
discharges of a foul nature. The immersion of the 
hands in alcohol, after a thorough cleansing with 
soap and water, and their subsequent immersion in 
a strong bichloride solution is probably sufficient 
for producing an antiseptic condition in ordinary 
cases. 

Surgical Before beginning the operation the operator and 

his assistants should put on long white linen 
aprons, enveloping the whole person, which should 
previously have been sterilized by steaming in the 
Arnold apparatus for one hour before operation, or 
by superheating in the sterilizing oven for a similar 
length of time. 

cV'contami- During the operation the surgeon and his assist- 
ants should carefully avoid touching anything that 
may contaminate their hands. Should they have 



nation. 



PREPARATION OF OPERATOR. IOI 

to do so, the process of recleansing the hands 
should again be gone through with. A frequent 
dipping of the hands into the warm sterilized water 
provided will keep them free of blood and also con- 
duce to greater safety in the performance of the 
operation. 



CHAPTER X. 



THE NURSE'S DUTIES DURING OPERATION. 



Personal 
cleanliness 
of nurse. 



Arrange- 
ment of 
patient for 
operation. 



After a careful preparation of the room and of 
the patient, according to the instructions laid down 
in the preceding chapters, the nurse will need to 
make the changes in her own toilet necessary to 
her attendance upon the operation. Her hands 
and fore-arms will need to be rendered thoroughly 
aseptic, and a clean apron with sleeves put on. 
The general bath and change of clothing should 
have been obtained before her preparation of the 
patient. 

When ready herself the nurse should assist in 
taking the patient into the operating room, placing 
her on the table and arranging the clothing and pro- 
tectives. After doing this, if she is not otherwise 
directed by the surgeon in attendance, she can see 
to arranging such details as have had to be left to 
the last ; as placing sterilized water of the proper 
temperature in the various vessels provided for the 
purposes of irrigation, cleansing of sponges and 
hands, etc. A good temperature to start with is 



no° or 1 1 5 Fahr. 



1 02 



NURSES DUTIES DURING OPERATION. IO3 

She should see that hot bottles or foot-warmers Warming 
are placed in the bed which is to receive the 
patient after operation. She should take a careful 
survey of the room and see that everything is in 
its proper place, that is, where it may be most 
readily obtained when wanted. 

After assuring herself that all is right, she should Manage- 

& . mentof 

recleanse her hands and take up her station at the sponges. 
stand wjiere she is to manage the sponges. 

As rapidly as the soiled sponges are thrown into 
the cold-water basin, she should cleanse them of 
blood, rinse them out of the hot water, and place 
them in the basin on the stand to the assistant's 
right. 

She should keep her eyes open to the needs of special 
the operator and his assistants, supplying sponges, 
clean towels, etc., as needed ; keeping the water in 
the various basins changed as it becomes soiled, 
and finally assisting with the removal of the soiled 
clothing, the application of dressings, and the re- 
moval of the patient to the bed. While the surgeon 
is completing his application of the dressings the ao^ofbed 
nurse should turn back the covers from the bed, jj r n re c f ep " 
and remove the hot-water bottles, etc., temporarily, patient - 
placing them under the bed to be out of the way 
until the patient has been placed in bed, when they 
may be replaced around her. 

The nurse's hands should be frequently cleansed 



104 



NURSING IN ABDOMINAL SURGERY. 



Attention 
after 
patient is 
placed in 
bed. 



Removal 
from room 
of articles 
used during 
operation. 



Care of 

soiled 
clothing. 



Ventilation 
of room. 



as she passes from one thing to another in her 
attention to the various details of service. 

When the patient has been placed in bed and 
warmly covered with blankets, the hot applications 
being placed around her, a towel should be placed 
under her chin, a light basin under the head of 
the bed to be on hand should she vomit, and a 
towel wrung out of cold water may be placed 
upon her forehead. The blinds or screens, should 
be so arranged that the light in the room may be 
modified. A chair for the surgeon may be placed 
at the head of the bed, and, as he or his assistant 
takes his place there, the nurse may attend to 
speedily removing the things used during the oper- 
ation, as tables, protectives, etc., from the room. 
These may be placed temporarily in an adjoining 
room, until the nurse or some one who volunteers 
to assist her may see the different articles taken 
back to their respective places in the house. 

Sheets, etc., soiled with blood, should be placed 
in a tub to soak. This will render the washing of 
them quite easy, as the blood being well-rinsed out 
of them, they may then be placed in the ordinary 
wash, unless it is preferred to do them separately. 

Screens being placed around the bed to prevent 
the patient's feeling the draught, the windows 
should be raised and doors opened to thoroughly 
change the air in the apartment. This may more 



NURSES DUTIES DURING OPERATION. IO5 

effectually be done by " pumping the door," as it is 
called, that is rapidly opening and closing it, 
without latching, so as to use it as a fan as it 
swings upon its hinges. 

When the surgeon has to leave the patient, the The nurse's 

x watch over 

nurse must take up her station by the bed. Like patient's 

1 J condition. 

a sentinel on duty, she should be vigilant in her 
watch, noting every symptom promptly and meet- 
ing its demands. Until the patient is well out of 
ether the nurse should not entrust her care, even 
for a moment, to any inexperienced person. 



CHAPTER XL 

THE NURSE'S DUTIES AFTER OPERATION AND 
DURING CONVALESCENCE. 

The immediate duties of the nurse after opera- 
ation will depend much upon the condition in 
which the patient has been put to bed. 
Treatment If the condition of shock be profound, vigorous 

of shock. r ' fe 

measures may be necessary to produce a reaction. 
The application of dry heat, by means of blankets 
heated in an oven and tucked closely around 
the patient, and of pieces of flannel heated and 
placed over the chest immediately next the skin, 
serves to stimulate the circulation. The extremi- 
ties may be rubbed with whiskey or brandy, the 
nurse's hands being carried under the blankets to 
avoid exposure to air. The head should be kept 
low, even lower than the feet, in order to keep up 
the circulation of blood in the brain. The foot of 
the bed may be elevated for this purpose, being 
raised by means of bricks or stools, or a high chair 
upon which a stool has been placed may be slipped 
under the foot-board. 

The patient may be fanned, and hartshorn 
sprinkled on a handkerchief or towel held near the 

1 06 



nurse's duties after operation. 107 

nostrils. Should further measures be necessary 
the nurse may, with the sanction of the surgeon, 
give hypodermic injections of some stimulant. 
Brandy or whisky may be thus given, or solutions 
of caffeine, strychnia, or digitalis. These are in- 
tended to strengthen the heart's action, and, if 
doing their work properly, the effect should be soon 
noted in the pulse. It should grow stronger and 
slower. The frequency with which these injections Hypoder- 
should be given and the amount given at one time, SimSfams 
will in every case need to be regulated by the sur- 
geon. Careful instructions must be obtained from 
him. The full 30 minims of brandy or whisky 
may be given, filling the barrel of the syringe full. 
Ten to fifteen minims of tincture of digitalis gen- 
erally constitutes a dose. It may be diluted in 
sufficient water to fill the barrel of the syringe. One 
to two grains of caffeine in solution, or -^ gr. of 
strychnia in solution, may be given by computing 
the dose according to the strength of the solution 
compounded. 

The hypodermic syringe is a delicate instrument careof h y - 
and should be carefully managed and kept in good syringe. 
order, so that it may be ready for use at any time. 
The barrel may be of metal, glass, or rubber ; the 
nozzle or needle of gold, silver, or steel. The 
latter should be very sharp, hence the point should 
be kept well protected. If dulled its introduction 



io8 



NURSING IN ABDOMINAL SURGERY. 



will cause pain. After use, a fine gold wire should be 
run through it, from the point of the needle 
upward, to keep out dust, etc. The barrel should be 
kept filled % full of water to keep the packing of 
the piston soft. Should the packing become loose, 
draw out the piston and slip the fingernail around 
the upper part of the packing, and spread it a little 
and soak in a little warm water for a time. A 
screw-piece attached to the piston enables a more 

Fig. 27. 




Hypodermic Needles and Syringe. 



Method of 
hypoder- 
mic injec- 
tion. 



accurate regulation of the dose, when it has to be 
estimated in minims. In administering the injec- 
tion take hold of a portion of the upper part of the 
arm or thigh and hold it firmly for a little time to 
benumb sensation ; then insert the needle quickly, 
but not too deeply, straight down into this mass and 
carefully inject the fluid. After withdrawing the 
needle put your finger over the point from which 



nurse's duties after operation. 109 

it was withdrawn, and rub over the place for a little 
time to prevent any of the fluid coming back. 

When the patient's strength is low, stimulating stimulating 

m or nutrient 

or nutrient enemata are often given. For simple enemata. 
stimulation a gill of black coffee, strained and care- 
fully injected into the bowel, is excellent. 

As a feeding enema, milk, beef-tea, broth, etc., 
alone or combined with stimulants, may be 
employed. All feeding enemata should be pep- 
tonized to render their digestion and assimilation 
easier, for there is but little digestive power in the 
lower bowel. 

The amount given to an adult at one time should 
not exceed 1 gill, and should not be given oftener 
than once in 3 or 4 hours. It is better to give highly 
concentrated food, rather than to give these injec- 
tions too frequently, for the bowel is thus irritated 
and will not retain the food given. 

A tablespoonful of expressed beef-juice, which 
represents the nutriment from *£ pound of beef, 
may be combined with a gill of warm water, to 
which whisky or brandy may be added from 1 tea- 
spoonful to 1 tablespoonful, according to the sur- 
geon's desire. 

This given once in 3 hours will represent consid- 
erable nourishment. Medication may be combined 
with the food thus given, as 15-20 drops tincture 
of digitalis or aromatic spirits of ammonia. 



110 



NURSING IN ABDOMINAL SURGERY. 



Method of 
giving in- 
jections. 



The injection should be given at a temperature 
of ioo° Fahr. If too warm or too cold, it will 
stimulate the action of the bowels. 

An ordinary Davidson hand-ball syringe may be 
used as a siphon for the introduction of this enema 
from the cup containing it. Care should be taken 
to inject no air into the bowel. It is well to intro- 
duce a vaginal nozzle into the bowel a few minutes 

Fig. 28. 




DAVIDSON RUBBER CO. 



Davidson Syringe. 



Washing 
out bowel. 



before the time for giving the enema, to allow of the 
escape of any gas that may have collected and 
thus better insure the retention of the food. A 
bowel used thus for purposes .of nutrition should 
be washed out at least once daily, to remove any 
residue that may collect and prevent ready absorp- 
tion. This may be done by injecting a pint of warm 



NURSES DUTIES AFTER OPERATION. Ill 

water in which has been dissolved a teaspoonful of 
salt. If this is not voluntarily evacuated a nozzle 
may be inserted to draw it off. To administer 
the stimulating enema itself, all air is first expelled 
from the syringe by keeping the ends beneath the 
surface of the mixture and compressing the bulb 
until no bubbles are produced. A little vaseline 
may then be used to anoint the nozzle, which is 
then carefully insinuated into the bowel. If the 
direction of the lower bowel is remembered by the 
nurse as first extending for a short distance toward 
the vagina and then inclining backward, there will 
be no difficulty experienced in introducing the nozzle 
without causing any pain. The nozzle must then be 
held in place. The patient, if strong enough, can 
do this for herself, and the nurse will raise the vessel 
containing the mixture to be injected. As soon as 
the last of the liquid flows into the syringe,. the 
tubing should be compressed while the nozzle is 
withdrawn. This is to prevent the introduction of 
air into the bowel. A napkin may then be held Method of 
firmly applied for a time to the anus, until the tention gre 
irritability of the bowel ceases. 

The addition of white of egg beaten into the 
mixture, or a teaspoonful of starch or arrowroot, 
will serve to make the liquid injected less irritating 
to the bowel. When the bowel becomes non- 
retentive the addition of from 10 to 15 drops of 



112 



NURSING IN ABDOMINAL SURGERY. 



Period in 
which 
danger 
from hem- 
orrhage ; 
from 

inflamma- 
tion ; from 
blood-poi- 
soning. 



Symptoms 
of internal 
hemor- 
rhage. 



Primary- 
hemor- 
rhage. 



Secondary 
hemor- 
rhage. 



Reaction 
after opera- 
tion. 



laudanum to the enema may enable it to be re- 
tained. Opium in any form should not be used 
without the express direction of the surgeon. If 
preferred, a barrel and piston syringe may be used 
in giving these injections. 

The precaution should be taken to inject the fluid 
very slowly. 

The greatest danger in the first twenty-four 
hours after operation is from hemorrhage ; in the 
first three or four days from inflammation ; and the 
first ten days from blood-poisoning. The nurse 
should look frequently at the dressings and the 
clothing under the patient's back to see if there be 
any bleeding. 

If there is internal bleeding it will show itself by 
the patient being faint, white or blue around the 
lips, and the pulse becoming very faint and rapid, 
or else altogether lost. Hemorrhage occurring in 
the first twenty-four to forty eight hours after 
operation is called primary hemorrhage. Second- 
ary hemorrhage comes on generally in the second 
week. 

Reaction after operation is shown by the patient's 
speaking, the pulse getting stronger and the skin 
becoming moist and warm. When this occurs it 
is undesirable to keep up too much artificial heat 
about the patient. The heated bottles, etc., around 
her may therefore be removed. 



NURSES DUTIES AFTER OPERATION. I 1 3 

The temperature, pulse, and respiration of the Record of 
patient should be taken immediately after she is ture,etc. 
placed in bed, and after that every 3 hours for the 
first few days. The temperature is best taken in 
the arm-pit. 

For the sake of uniformity it is well to make the Special 

symptoms 

record of temperature, pulse, etc., come at 12, 3, 6, to be noted. 
and 9 o'clock. 

The nurse should note all symptoms accurately 
and report them carefully. If the patient is uneasy 
or complains of pain, note this down in the record. 
If she is sick or vomits, report the time, quantity, 
and appearance of the matter vomited. 

During any retching or vomiting the nurse should 
place one hand over the site of the wound, to pre- 
vent undue strain upon the stitches or the forcing 
out of the drainage tube. 

The quieter the patient is kept the better, there- 
fore no conversation should go on in the room. 
Do not let the patient lift her head or move her 
limbs. Report chills or chilliness. Give just as 
little nourishment as possible for the first few days, 
unless directed otherwise by the surgeon. 

The ordinary rule for feeding after a laparotomy Manage- 

1S as follows : diet. 

For first 24 hours absolutely nothing, not even 
ice or water. If the lips and mouth are much 
parched with ether, a small soft piece of linen cloth 
8 



114 NURSING IN ABDOMINAL SURGERY. 

may be dipped in cold water and used to moisten 
the mouth and tongue. 

If the stomach is settled the patient may on the 
second day take a teaspoonful of barley water every 
hour. If this is retained she may on the third day 
have a teaspoonful of milk combined with the 
barley water. When the bowels have been once 
thoroughly moved, as they should be by the third 
day, the dietary may be increased. The food at 
first should be concentrated rather than large in 
quantity. As the amount is increased the intervals 
should be lengthened, thus, a tablespoonful of 
expressed beef-juice may be given alternating with 
a tablespoonful of milk once in two hours. 

Should the liquid diet tend to produce flatulence, 
bread-crumbs may be used with the milk and beef- 
juice, or a partial semi-liquid diet may be substi- 
tuted; thus, farina, junket, wheat-germ, thickened 
milk, koumiss, toast milk, wine whey, strained 
gruel, rice, milk-toast, broths containing rice or 
barley may gradually be substituted. By the close 
of the second week the patient may gradually 
resume ordinary, plain, wholesome fare. The 
occasional use of a baked apple, or a dish of stewed 
apples, will aid in regulating the bowels. Should 
the patient's stomach be retentive and her general 
condition good, an occasional drink of very weak, 
hot tea, in place of the barley water, on the second 



NURSE S DUTIES AFTER OPERATION. I I 5 

and third days will be found, by relieving the feel- 
ing of exhaustion, to steady the nerves and add to 
the patient's comfort. For the control of vomiting Control of 

1 ° vomiting. 

various devices have been recommended. 

As the vomiting after ether is largely the result 
of cerebral congestion, it is desirable to keep the 
head cool by the application of cloths wrung out in 
ice water or icebags. This relieves also the 
accompanying headache. 

A mustard-paste placed over the stomach will 
be sedative in its effect upon the vomiting. Should 
the tendency continue notwithstanding this treat- 
ment, a feeder full of very hot water containing a 
small pinch of salt, may be sipped by the patient. 
This will probably come up, but will serve to quiet 
the tendency to retching. Another means which 
is often effectual is that of injecting about y 2 pint 
of warm water (105 Fahr.) into the rectum and 
having it retained. 

Intestinal colic is frequently complained of, es- intestinal 
pecially during the second and third day. It is 
caused by the accumulation of gas in the intestines. 
There is apt to be such an accumulation in the 
large bowel, just below the diaphragm, causing the 
patient often to cry out with pain. The use of a 
warm flaxseed poultice over this region will relieve 
the pain and enable the gas to work down into the 
lower bowel. The use of the vaginal nozzle in the 



Il6 NURSING IN ABDOMINAL SURGERY. 

rectum will enable it often to be expelled and thus 
relieve the pain. The drink of hot tea or very hot 
water will also aid in this result. 
V M°L The nurse should learn from the surgeon what 

catheter. o 

his desire may be concerning the use of the catheter. 
Unless especial directions are given the catheter 
may be used once in six hours. 

After hysterectomy it may be necessary to empty 
the bladder once in every three or four hours, if 
the stump is so situated as to interfere with its 

Fig. 29. 



Glass Catheter. 

proper distention. The silver or glass catheter 
should be used, or the soft rubber catheter. Great 
care should be exercised by thorough cleanliness 
to produce no irritation from its use. The instru- 
ments, if glass or silver, should be boiled after each 
use, and kept in the intervals in a weak solution 
1-40 of carbolic acid. The part around the orifice 
of the urethra should be carefully cleansed before 
the insertion of the catheter. The catheter itself 
should be well lubricated with a little carbolized 
vaseline. 



NURSES DUTIES AFTER OPERATION. II7 

It is probably best to insert the catheter by sight, Methods of 
the efforts to do it by touch, unless one is especially catheter, 
skilled, often inducing irritation. The patient may 
be so protected by the covers that but little ex- 
posure is necessary in its use, a blanket or sheet 
being thrown over each limb, the urinal being 
placed between them. Should the nurse be able to 
use the catheter by touch, the operation can be per- 
formed without any exposure beneath the covers. 
The index finger of the nurse's right hand should 

Fig. 30. 




Coach Urinal. 

be slipped into the vagina as far as the second joint, 
and made to follow the anterior vaginal wall down 
in the median line to the vaginal entrance, when a 
little elevation of the surface will be felt, immediately 
above which the orifice of the urethra is to be 
found. If the finger be held with its palmar sur- 
face upward and resting lightly upon this elevation, 
the finger being held horizontally, a catheter 
slipped along it will enter the small orifice of the 
urethra. Should the extremity of the catheter 



u8 



NURSING IN ABDOMINAL SURGERY. 



seem to meet with any obstruction after its en- 
trance into the urethra, a slight withdrawal and 
rotation of the instrument will generally carry it in. 
After the catheter has been withdrawn the parts 
should be cleansed and dried > 
Urinals. Should the patient be allowed to pass her own 

water, the tin slipper urinal or the china or glass 
urinal made to fit over the vulva may be employed. 
Should there be difficulty in urination, fomentations 
applied over the vulva, or hot water in the urinal 
or bedpan will sometimes aid its accomplishment. 

Fig. si. 




Female Urinal of China or Glass. 



Notes con- 
cerning 
character 
of urine. 



Saving of 
napkins 
for inspec- 
tion. 



The urine drawn should be measured and tested 
with litmus paper, and a note made on the record 
of its amount, appearance, and reaction. If there is 
anything peculiar in its appearance, that is, if it is 
smoky or bloody, or contains sediment, save it for 
the surgeon's inspection at his next visit. 

The same should be done with napkins contain- 
ing any discharge that may come from the vagina, 
and the fact should be reported on the nurse's 
record. 



NURSES DUTIES AFTER OPERATION. I 1 9 

Report also any cough ; state what kind it was Report of 

1 1 «1 1 -r» 1 • cough, etc. 

— tight or loose — how long it lasted. Report hic- 
coughs. Report also the character of the sleep, as 
heavy, quiet, uneasy, or if the patient snores. Re- 
port if the patient complains of the bandages feel- 
ing tight, for inflammation is shown by the disten- 
tion of the abdomen. Report any change that may 
be seen in the patient, and send the doctor word 
concerning it, if it is at all serious. The tempera- t ^.™P f era " 
ture of the room should be kept at from 68° to jo°. room - 
It should not be allowed to vary. The patient 
should be carefully kept from all draughts, but 
thorough ventilation of the apartment should be Hygienic 
obtained. Screens carefully adjusted enable this to SSS" 1 " 
be accomplished. All discharges, wash water, etc., 
should be at once removed from the room. The 
slop-jar for the wash water should not stand in the 
sick-room, but in an adjoining room. 

After an evacuation of the bowels especial care 
should be taken to change the air of the apart- 
ment. The bedpan should always be carefully 
covered in its removal to the water-closet. A 
newspaper or napkin may be thrown over it, if it 
has no cover of its own. 

An early evacuation of the bowels is very de- Method of 
sirable after an abdominal section. The exact evacuation 11 
period will be dependent upon the patient's condi- ^opera- 
tion. Should all go well and the patient suffer 



120 NURSING IN ABDOMINAL SURGERY. 

little from flatulence, it is not necessary to make 
any effort to have the bowels moved before the 
third day. At that time means should be taken to 
have a movement with as little straining as possible. 
A rectal injection of a gill of cotton-seed or sweet- 
oil with a tablespoonful of turpentine maybe given, 
and should be retained, if possible, about two hours, 
when a soap-and-water injection may be given. 

A very good method of securing a movement is 
by the enema composed of Epsom salts, oil, tur- 
pentine and glycerine combined with water, which 
has already been mentioned in the chapter on 
Preparation of the Patient. 

This enema is almost always followed by an 
immediate evacuation of the bowels. 

After this has been secured, any irritability of 
the bowel that may ensue, may be allayed by the 
injection of about I gill of warm water containing a 
little table salt in solution. This is to be retained. 
Adminis- Should enemata fail to secure a satisfactory evac- 

saitsby uation, salts may be administered by mouth. A 
teaspoonful of Rochelle salts may be given dis- 
solved in a tablespoonful of hot water, and followed 
by a few sips of hot water. This dose may be re- 
peated every hour, should the patient retain it, until 
from four to six doses have been taken or the 
bowels feel like moving. This followed by the use 
of a simple soap-sud enema will, as a rule, have the 



NURSES DUTIES AFTER OPERATION. 121 

desired effect. The salts are best administered in 
this concentrated form when it is desired to secure 
prompt effect. The nauseating effect of the dose 
may be avoided by a little circumspection in its ad- 
ministration. The solution of the salts should be 
placed in one feeder, and the hot water to be 
sipped, in a separate feeder. The patient should 
be directed to put the spout of the feeder as far 
back in her mouth as she can, and to swallow the 
salts quickly, not allowing any to touch the tip of 
the tongue and the lips, where the sense of taste is 

Fig. 32. 




Feeder. 

strongest. She may follow this immediately with 
the sips of hot water from the feeder on hand. The 
nurse should place her hand beneath the pillow and 
slightly raise the head of the patient in giving her 
anything to swallow. A napkin should be placed 
beneath the chin to prevent spilling on the clothing. 
This rule for administration should be followed in 
giving food as well as medicine. 

The use of the bedpan involves considerable Use of 

. -i •. . « . 1 . / - bedpan. 

risk to the patient unless great care is used in lift- Methods of 

employing. 

mg her. Particularly is this true in cases of hys- 



122 



NURSING IN ABDOMINAL SURGERY. 



terectomy, when there is greater danger from the 
occurrence of hemorrhage or from formation of 
clots in the blood-vessels. The nurse should not 
attempt to perform this duty alone, unless she is 

Fig. 33. 




QBTiIiMilIij_ 

Slipper Bed-Pan. 

fully equal to lifting the patient without jarring. 
Should the patient be slight and of light weight, 
the nurse may place one arm under the patient's 
knees, slightly lifting the hips. With the other 
hand the bedpan may be slipped under them. 

Fig. 34. 




Eureka Bed-Pan. 

Should the patient be heavy, she is better lifted by 
placing one hand under each hip and slightly raising 
her thus from above. Another attendant can then 
slip the pan under. The same manoeuvre should 
be resorted to in removing the pan. 



NURSES DUTIES AFTER OPERATION. 1 23 

Should the patient be too feeble or the nurse un- 
able to get the proper help, the tin-slipper urinal is 
a convenient receptacle to use, and will involve no 
lifting. It is well to have two of these to use inter- 
changeably, because of their small size. 

Should the nurse not have these, she may use Pads as 

substitutes 

pads made of newspaper and soft rags or oakum, forbed- 
which can be worked under the patient without 
any lifting, and which, after use, can be simply 
rolled up and burned. The amount and character t ^ a £ t e ic r "! ars 
of the movement should be carefully recorded on p° rted - 
the report, as also should the fact as to the expul- 
sion of gas from the bowel at any time. 

The patient should be scrupulously cleaned after 
these movements, and the parts kept thoroughly 
dry. Especial care should be taken to see that 
there is no moisture under the back and that the 
skin is kept from breaking. The surface upon 
which the patient lies should be perfectly smooth. 
Wrinkles tend to produce sores. Bedsores may Prevention 

r J 01 bedsores. 

develop in so short a time as the result of pressure 
and moisture that a nurse must exercise the great- 
est vigilance in their prevention. Rubbing the back 
daily at least once or twice with a little alcohol and 
alum serves to harden the skin. This may be fol- 
lowed by rubbing with powdered oxide of zinc or 
starch or bismuth subnitrate as a drying powder. 
When the skin has broken the treatment must be 



124 



NURSE S DUTIES AFTER OPERATION. 



changed. Some ointment will be necessary to 
soothe and heal the raw surface. The alcohol and 
alum, if used, would cause pain and irritation. 
Borated or carbolized zinc ointment applied on lint 
and held on with adhesive strips will constitute the 
best dressing. A most important feature of treat- 



ment is relief from pressure. 



A ring 



cushion of 



Fig. 35. 




Rubber Air- Cushion. 



Location of 
bedsores. 



rubber may be used for this purpose, being placed 
beneath the patient in such a way that the bedsore 
shall rest over the hole in the ring. When a rub- 
ber cushion cannot be had the nurse may make a 
circular cushion of the kind, filling it with soft rags 
or hair. 

Bedsores may come on any part of the body 
which is subjected to pressure, as the shoulder, the 
elbows, the lower part of the back and the heels. 



NURSES DUTIES AFTER OPERATION. 



125 



The skin over the sacrum, or end of the backbone 
is probably the most frequent site for such a sore. 
Skill in the management ofa drainage tube is one 
of the most important qualifications on the part of 
the nurse. The methods employed by different 
operators vary somewhat, hence the nurse must 



Fig. 36. 




\JE.*VT "Z. IK.SQN5 



Glass Drainage Tube. 

obtain explicit directions from the surgeon in 
charge of a case. 

The intervals may be, according to his choice, 
from once every half hour to once in twelve hours 
or more. 

Fig. 37. 



Glass Syringe for Draining Tube. 



Draining of the tube by means of a syringe Method of 
may be accomplished either with the barrel and 
piston syringe of glass or hard rubber, to which a 
piece of rubber tubing is attached, or by what is 
known as the hard-rubber uterine syringe with long 



126 NURSING IN ABDOMINAL SURGERY. 

nozzle. These syringes should be kept in the inter- 
vals of use in an antiseptic solution, as 1-4000 bi- 
chloride of mercury. The sponge taken from over 
the drainage tube should be put in a weak carbolic 
solution until again wanted. A small glass graduate 
is convenient for receiving the fluid drawn from 
the tube and accurately recording its amount. 

In making preparations for draining, the nurse 
should first arrange the covers over the patient's 
chest and over the lower limbs, so that just the 
portion of the body covered by the abdominal 

Fig. 38. 




Hard Rubber Syringe for Draining Tube. 

bandage shall be exposed to view. She shall then 
thoroughly cleanse her hands, rendering them 
aseptic and loosen the bandage and rubber dressing. 
Again washing off her hands in an antiseptic solu- 
tion, she should lay back the rubber covering of 
the tube, remove the sponge, closing over its orifice, 
placing it in a carbolized solution, and take up the 
syringe with which she is going to drain the tube. 
The rubber tubing or the nozzle is allowed care- 
fully to slip down through the glass drainage tube 



NURSES DUTIES AFTER OPERATION. \2J 

into the abdomen. If the extremity of the tube is 
felt to meet with a point of resistance, it should be 
drawn back a little before suction is effected by 
drawing on the handle of the syringe. The syringe 
should be very carefully and slowly filled and then 
drawn out. A corner of the rubber protective may 
be thrown over the mouth of the tube until the 
syringe is emptied and rinsed out. The contents 
of the syringe may be emptied into the glass 
graduate provided. The use of the syringe is con- 
tinued until no liquid remains. The sponge is then 
squeezed out of the carbolic solution and replaced 
over the drainage tube. The corners of the rubber 
protective are folded back over the sponge and 
pinned, and the bandage, if need be, readjusted. 
The liquid drained should be placed in a small 
labeled bottle — of which a number should be pre- 
pared before the operation — and the date and hour 
with the record of the amount drained should be 
placed on the label. This enables the surgeon to 
obtain an accurate idea of the character of the 
drainage. 

When the hard rubber syringe is used care must 
be taken not to jar the sides of the drainage tube. 
Unless the syringe works easily this is apt to be 
done. The suction also may be so strong that 
portions of omentum or bowel may be drawn into 
the tube through its perforations. 



128 NURSING IN ABDOMINAL SURGERY. 

Capillary A third method of draining is by what is known 

drainage. . . 

as capillary drainage; a twist of sterilized cotton or 
gauze is placed down into the drainage tube and 
sucks up the liquid. The dressing over the mouth 
of the tube thus becomes saturated and requires 
changing. Some surgeons like the tube cleansed 
by means of small tampons of sterilized cotton, 
carried down into it by means of a long, slender 
pair of forceps, very like the uterine dressing for- 
ceps. A new twist of cotton is then placed in the 
tube. The amount of fluid drained should be 
recorded on the nurse's report, and its character 
described each time. When the liquid becomes 
pale, losing its bloody hue, it is pure serum, and 
the surgeon will probably desire to remove the 
tube. The nurse will need to prepare a basin con- 
taining bichloride solution, about 1-4000, for the 
doctor's hands, and another with carbolic solution, 
1-40, for the instruments (scissors and forceps) 
which may be used. A tray containing fresh 
dressings and adhesive strips should also be ready. 
When the stitches are to be removed, which is 
usually during the second week, similar prepara- 
tions should be made. 
aftero g era- ^he advisability of bathing the patient during 
tion. for convalescence should be determined by the 

surgeon. The cleansing previous to operation 
having been so very thorough, it is, as a rule, un- 



NURSES DUTIES AFTER OPERATION. 1 29 

necessary to give a full sponge bath and change 
the clothing for about one week after. It would 
probably involve too much moving of the patient. 
The head, neck, chest, hands and arms may be 
sponged separately as occasion may call for it. 
The same may be done with the lower extremities. 
This is less exhausting than the general bath at 
one time. With sufficient care the patient's cloth- o^ckftSng. 
ing may be changed without moving her too much. 
This can only be done properly if the precaution 
has been taken to have the clothing very loose. 
In removing the nightdress and undervest, the 
sleeves should be slipped off on one side, and the 
arm and shoulder covered by a blanket. They 
may be then taken off the opposite side in the same 
way. The sleeves of the fresh undervest having 
been drawn through the sleeves of the fresh night- 
dress, the two garments may be slipped on at once. 
The sleeves of one side may be drawn on and then 
those of the opposite side. An assistant slipping 
her hands under the shoulders and slightly raising 
them, the nurse may draw out the soiled clothing 
from beneath the back, and slip the neck of the 
fresh undervest and nightdress over the patient's 
head, drawing the garments well down and smooth- 
ing out all wrinkles under the back. The sleeves 
also should be straightened, so that there may be 
no feeling of constriction under the armpit. The 
9 



130 NURSING IN ABDOMINAL SURGERY. 

drawers may be changed without much moving, 
as it is not necessary to draw them under the back 
and fasten them. 

The abdominal bandage and dressings can be 
better managed when the drawers are allowed to 
remain as a loose covering for the limbs. The 
change of stockings involves no disturbance of the 
patient. Greater difficulty will be experienced in 
blddfth* changing the bedclothing beneath the patient. If 
in s- the draw-sheet is kept carefully changed and the 

covers, a change of the other bedclothing may be 
deferred — unless in case of accident — until the sec- 
ond week. To change the draw-sheet, unpin it 
from its fastenings and pin one end of the fresh 
draw-sheet, properly folded, to one end of the sheet 
to be removed. 

As the hips of the patient are slightly raised by 
the nurse, the soiled draw-sheet can be quickly 
drawn out and the new one drawn under the pa- 
tient by an assistant on the other side of the bed. 
The fresh draw-sheet may then be unpinned from 
the soiled one and its ends tucked under the mat- 
tress and pinned. 

The pillow will need to be removed, beaten, 

turned and the slips changed quite frequently. 

The comfort of the patient is greatly increased by 

an occasional turning and adjustment of the pillows. 

If two beds have been provided to be used 



NURSES DUTIES AFTER OPERATION. I 3 I 

interchangeably during the patient's convalescence, 
the change may be easily effected by lifting the 
patient from one bed into another. It is necessary 
to have three persons to do this without jarring. All 
three should stand on the same side of the bed, 
the tallest nearest to the patient's head, the shortest 
nearest the feet. The attendant nearest the head 
should place one arm under the patient's neck, so 
that the head may lie upon it, and gain a secure 
hold with the hand of the same arm under the 
axilla on the opposite side of her. The other arm 
should be extended just below the shoulder blades. 

The second attendant places one arm under the 
small of the back and the other arm just below 
the buttocks. The third assistant places one arm 
under the knees and the other under the ankle. 
When all three have their arms properly adjusted, 
a signal — "Now!" — may be given by one of them, 
and all must lift simultaneously. 

This will enable the patient to be raised without 
the slightest jar and transferred to the new bed. 
The latter should have been placed conveniently 
near, the covers folded back, and the pillow placed 
so that it will be at the right end of the bed for the 
patient's head when the nurses turn around in lift- 
ing her from the one bed to the other. 

When two beds cannot be had, the least dis- 
turbance is probably produced in the changing of 



132 NURSING IN ABDOMINAL SURGERY. 

the bedclothing by unfastening the undersheet or 
blanket and the draw-sheet upon which the patient 
lies, rolling them up from one side of the bed close 
to the patient, adjusting a fresh draw-sheet to a 
fresh undersheet, rolling them up lengthwise and 
spreading so far as possible over the uncovered 
side of the bed, tucking them under the mattress at 
the side. The remainder of the two sheets is gath- 
ered into a roll and carried close up to the roll 
made by the soiled clothing. If the patient can be 
turned on her side, both these rolls may then be 
carried well under her as she turns on the opposite 
side, and in turning back she will turn over them, 
thus enabling both the soiled clothing and the fresh 
to be carried through to the opposite side and 
properly adjusted to the bed, the soiled clothing 
being removed. Should it be considered unwise 
to let the patient roll on her side, her hips may be 
slightly lifted and the rolls of soiled and fresh 
clothing drawn through by an assistant who stands 
on the opposite side. The same manoeuvre can be 
carried out with the shoulders and the lower ex- 
tremities until the fresh clothing is properly ar- 
ranged. 

Another method is that of drawing the patient 
well to one side of the bed on the sheet upon which 
she lies. The fresh sheets may then be placed 
over the rest of the bed and gathered into a roll 



nurse's duties after operation. 133 

close to the patient's side. The patient may then 
be lifted or drawn over on to the fresh sheets. The 
old sheet may be gradually removed from under 
her and the remaining portion of the fresh sheets 
unrolled and spread over the uncovered portion of 
the bed. 

The covers can be changed by spreading the fresh 
sheet and blanket over the former covering, and 
working the latter down to the foot of the bed be- 
neath these, thus removing them. 

The limbs of the patient frequently become be- Massage 

x x ■* for passive 

numbed and ache for want of exercise. The nurse exercise - 
may help this by rubbing them and gently knead- 
ing the muscles from time to time. It is not neces- 
sary to remove the clothing for this. There is 
generally no objection to slightly bending the limbs 
at the knees and supporting them on a pillow. 
Small pillows, 6 inches wide and 8 to 12 long, made 
of hair, are convenient for placing around the 
patient to remove pressure and produce slight 
changes in the position which are restful. 

Before sitting up the patient should be fitted with Necessity 

° L l for abdomi- 

a bandage for the support of the abdominal walls. nalsu P- 

° * * porter. 

As a rule, this bandage should be worn for one 
year, being removed only at night or when the 
patient lies down. This is to prevent rupture at 
the site of the incision. The bandage usually em- 
ployed in the " Woman's Hospital " is that known 



134 



NURSING IN ABDOMINAL SURGERY. 



as the London Supporter. A modification of this 
has been employed in cases of long incision reach- 
ing above the umbilicus. When there is not much 
strain upon the abdominal walls the ordinary elas- 
tic abdominal bandage serves the purpose very 
nicely. Great circumspection should be employed 
regarding the patient's sitting up after she has suf- 
ficiently convalesced to do so. 



Fig. 39. 




The first 
sitting-up. 



The period at first should be short. It is better 
to lift the patient out on a sofa or reclining chair 
for a change, rather than allow her to overexert 
herself. The surgeon should be carefully consulted 
as to the amount and character of the exercise the 
patient may take. 

The general directions given in this chapter may 



NURSE S DUTIES AFTER OPERATION. 



135 



be greatly modified by different surgeons. The 
nurse must be prepared to respond to the require- 
ments of the surgeon in every case. A nurse Code of 

# ° m ethics in 

should never let it be known that her views differ nursing. 



Fig. 40. 




Elastic Abdominal Bandage. 



from those of her superior officer. It is right 
always for the surgeon or physician to plan the 
campaign in the management of a case. The nurse, 
if she serves under him, has but one duty — to obey. 



CHAPTER XII. 

MANAGEMENT OF COMPLICATIONS. 
canceofrise Rise of Temperature. — This symptom always 

of tempera- . . 

ture. should cause anxiety after an operation, especially 

when the temperature exceeds 102 Fahr., for it is 
so frequently the indication of blood-poisoning in 
one or another form. The rise, however, may be 
due to some other cause, as a cold, bronchitis, ague, 
or it may denote the approach of a menstrual 
period, or may accompany a discharge from the 
uterus, which is not infrequent a few days after 
operation upon the pelvic organs. Extreme excite- 
ment may similarly produce an elevation of the 
temperature for a time. The treatment of this 
fever must depend largely upon the cause. 

Means for When the temperature rises above 102° and 

reduction r 

of tempera- there is a similar increase in the pulse, some means 

ture. Jr > 

should be taken for its reduction. An ice-cap 
may be placed upon the head and should be kept 
on until the temperature has steadily gone down, 
remaining below ioo°. The face, hands, and wrists 
may be frequently sponged with cold water. Wet- 
packing is sometimes employed where the temper- 

136 



MANAGEMENT OF COMPLICATIONS. 1 37 

ature keeps very high, notwithstanding the ice- 
cap. 

The arms may first be packed in wet towels, 
wrung out in ice-cold water, and kept moist by 
water squeezed upon them from a sponge. The 
lower extremities and the chest may require the 
same treatment, if the application of cold to the 
arms fails to reduce the temperature. A rubber 
protective will need to be slipped under the patient 
when this treatment is carried out, to prevent 
wetting of the bedclothing. 

An icebag is sometimes directed to be placed 
over the heart for the reduction of temperature. 
When these means are employed the pulse and 

, r 1 -1 Sudden de- 

temperature must be frequently taken, as great pression 
depression may occur suddenly. The necessity for cation of 
keeping a patient very still will prevent the use of 
the fever-cot in the early days after operation. Fever-cot. 
Later, however, it may be employed. No heroic 
measures, such as the above, should, however, be 
employed without the full sanction of the surgeon. 
The use of antipyretic remedies will also be 
directed by him. 

The ice-cap ordinarily employed in this country i C e-ca P . 
is a simple rubber bag, which is filled one-third full 
of pieces of ice about the size of a walnut. All air 
should then be squeezed out of the bag and a piece 
of string fastened securely around the neck. The 



138 



DISEASES OF WOMEN. 



Noiseless 
method for 
cracking 
ice. 



Leiter's 
tubes. 



bag is then placed on top of the patient's head, 
a single layer of muslin or toweling intervening 
between them. If the bag is filled more than one- 
third full it will not adapt itself well to the shape 
of the head. Two bags should be in use at the 
same time, so that the nurse may have one to 
immediately replace the other when refilling of the 
bag is necessary. The ice melts so fast when the 
fever is high that the bag will probably need refill- 
ing about every 20 minutes or half hour. It is 
utterly useless for the purpose of reducing tem- 
perature after the ice has melted. 

The nurse will need to have ice close at hand 
for the purpose. A block wrapped in flannel and 
kept in a covered vessel in a cool part of the room, 
or in the adjoining hall, will enable her to keep up 
this application without much difficulty. With a 
large steel pin and with the piece of ice wrapped in 
a cloth the nurse may noiselessly break off the 
pieces required for filling the cap. The pin pressed 
firmly into the ice will cause it to separate into 
pieces, which can similarly be broken into smaller 
pieces if desired. When the rubber icebag cannot 
be had, a pig's bladder, obtained at a drug store for 
ten cents, serves the purpose very well, although it 
is more perishable. 

Pliable metal coils, through which cold water 
may be made to circulate continuously, are some- 



MANAGEMENT OF COMPLICATIONS. 



139 



times used for reduction of temperature. These 
are called Leiter's tubes. They may be adapted 



Fig. 41. 




Leiter's Tube Cap. 

for application to various parts of the body. The 
coils forming a cap are used for application to the 
head. 



140 



DISEASES OF WOMEN. 



Method of 
application 
of ice-cap. 



Leiter's 
tenlpera- 
ture regu- 
lator. 



Water-coils 
of rubber. 



A broad tape fastened under the chin holds the 
cap to the head. A reservoir containing the ice 
water is placed above the level of the patient's 
head and is connected by a piece of rubber tubing 
with the coils. A similar tube connected with the 
other end of the coils is placed in a receiving vessel 
on the floor. A slight suction made on the lower 
tube either by the mouth or by means of a barrel 
and piston syringe, establishes the siphon action. 
When the lower vessel is nearly full the position 
of the two vessels may be reversed. This continu- 
ous flow of water through the spiral cap may be 
kept up any length of time required. The water 
in the supply vessel should contain ice. 

Some surgeons use by preference Leiter's tem- 
perature regulator, a long and narrow set of coils, 
which may be bent so as to shape it to the back 
and sides of the head. It is thought that better 
results are obtained by the application of cold to 
this portion of the head. 

To mould these coils they should be bent over 
some firm convex surface, as the thigh, for, if bent 
by the hands, the coils will not lie parallel and they 
will be apt to become leaky. This regulator is 
connected in the same way as the cap with the sup- 
ply and receiving vessels. 

Thornton's icecap consists of a series of coils of 
stout gutta-percha tubing, joined together so as to 



MANAGEMENT OF COMPLICATIONS. 141 

form a cap. The tubing is flat on the inner side, so 
that a uniformly cool, smooth surface touches the 
patient's head. At the top of the cap one end of 
the tubing is connected with a pail filled with water 
containing ice. The tubing at the lower border of 
the cap terminates in a long free end which passes 
from the side of the patient's head into a bucket 
beside the bed. 

The pail supplying the water is fitted with a top 

Fig. 42. 




Rubber Water-coil. 

which may be regulated so as to allow the water to 
flow slowly. 

As the receiving pail fills, the water may be baled 
out and returned to the pail above. The ice must 
be kept supplied in the upper pail. Care must be 
taken in the use of the cap to see that the free tub- 
ing does not bend at an angle at any point and so 
obstruct the flow or escape of water. 



142 



DISEASES OF WOMEN. 



Fever re- 
ducer. 



Septi- 
caemia. 



Peritonitis. 



Symptoms 
of peri- 
tonitis. 



Symptoms 
of septi- 
caemia. 



A device consisting of a metallic reservoir for 
ice which surrounds the head — at a distance of a 
few inches from it — thus producing a layer of cool 
air around it, has been used to some extent in this 
country, particularly in the west. It is the invention 
of Mr. Edwin B. Magill, of South Bend, Wash- 
ington, and is said to have afforded good results in 
practice. It is called a " fever reducer " or " body 
cooler." 

Septicemia, Pycemia, Peritonitis. — Septicaemia is 
a diseased or poisoned condition of the blood pro- 
duced by absorption of putrid matter. 

Pyaemia is a similar condition produced by 
purulent infection. 

Peritonitis is inflammation of the peritoneum. 

The relations between septicaemia and peritonitis 
appear to be very close. 

The characteristic symptoms of the latter are 
violent pains in the abdomen, increased by the 
slightest pressure, often by simple weight of the bed- 
clothes, the pulse becoming very rapid and wiry. 
The temperature is not correspondingly increased, 
although somewhat elevated. These symptoms of 
acute peritonitis may pass into a condition indicat- 
ing septic infection. 

Septicaemia generally sets in between the second 
and the seventh day, with vomiting, steady rise of 
temperature, and simultaneous rise of the pulse. 



MANAGEMENT OF COMPLICATIONS. 1 43 

The complexion becomes muddy, the expression 
dull, a dark-red flush on the cheek, spirits at first 
depressed, later apathetic. 

Condition of tongue and skin varies considerably, 
as a rule, tongue rough, red, and dry, and skin dry 
until near death. The tongue may remain moist 
and skin act profusely throughout. 

It is a bad sign when flatus does not pass from 
the bowel, as is tympanites or distention of the 
bowels with gas. Another highly unfavorable 
symptom is persistence of vomiting, especially when 
the vomited matter is no longer frothy and white, 
but becomes green or dark. 

The treatment of septicsemia is preventive rather Treatment 

x * of septi- 

than curative. Septicaemia when it has once set in c^mia. 
is very unamenable to any kind of treatment. The 
surgeon sometimes reopens the abdomen and opemkm 7 
washes it out. The nurse will need to make the 
preparations for this as nearly as possible like 
those she made for the original operation. Thor- 
ough asepsis should be maintained. 

For the vomiting, if it be bilious or dark the washing 
stomach may have to be washed out. This may stomach for 
be done by means of the stomach pump or a piece 
of long rubber tubing fitted with a funnel. A 
weak solution of warm salt water is used for the 
purpose, being poured in through the funnel, and 
after sufficient has been introduced into the stomach 



144 DISEASES OF WOMEN. 

to fill it, as will be indicated by the retching of the 
patient, the funnel maybe inverted and placed over 
a waste pail below the patient, and, the tube acting 
as a siphon, thus carries off the fluid from the 
stomach. The introduction of the stomach tube 
requires no little skill on the part of the nurse. As 
a rule the surgeon attends to the matter himself. 
Should the nurse have it to do, she should proceed 
as follows : first lubricating the outside of the tube 
with a little glycerine she places the end of it in 
the patient's mouth and directs her to swallow it. 
This movement is aided by the nurse holding the tube, 
and as it enters the oesophagus (or gullet) gently 
forcing it down the required length. A black ring 
on the tube, as it approaches the teeth, indicates the 
point at which the nurse may regard the tube as 
sufficiently introduced, the ring being on a line with 
the teeth. The funnel is then connected with the 
outer end of the tube (if one does not form a part 
of the apparatus), and the nurse standing at a 
height on a stool or chair pours in the salt solu- 
tion slowly at a temperature of from ioo°-i05° 
Fahr. The patient will need to be well protected, 
a rubber cloth being fastened around the neck. In 
withdrawing the tube it should be done as quickly 
as possible to prevent retching. Shortly after 
each washing some liquid nourishment with the 
addition of stimulants, if necessary, may be given. 



MANAGEMENT OF COMPLICATIONS. I45 

Before the vomiting has become so excessive, or other 
before the stomach washing is attempted, it may be for control 

• ofvomiting. 

found to be of advantage to let the patient sip very 
hot water containing just a pinch of salt. This 
measure has been found, as a rule, preferable to the 
use of bits of ice, especially as it affects the patient 
afterward in her ability to take food and retain it. 

The temperature, if over 102 , should be reduced, Reduction 

17 ' 7 of tempera- 

if possible, by means of the icecap or other appara- ture - 
tus of the kind After the reduction of tempera- 
ture and washing out of the stomach, some cases 
of septicaemia get better, because the poison thrown 
off by means of the mucous membrane of the 
stomach is removed by the washing and not re- 
absorbed into the system. 

If flatus does not pass freely from the bowel, Enemata 

especially after the insertion of the rectal tube, sionof 
. . . . fl atus - 

enemata containing salts, glycerine, turpentine, etc., 

may be used. Should these prove unsatisfactory, 

salts may be given by mouth. Because of their ^f^of 

depressing effect, it is better to give such in small | alt ^ u t h' 

doses, as one teaspoonful of Rochelle salts dissolved 

in a tablespoonful of water, once in an hour, until 

three or four doses are taken. 

Doran recommends for the expulsion of flatus 

one-half teaspoonful of aromatic spirit of ammonia 

in a little hot water. Beef-tea or milk enemata 

combined sometimes with stimulants will be needed 

10 



I46 DISEASES OF WOMEN. 

in addition to what the patient takes by mouth, for 

the treatment of septicaemia requires the support 

of the patient's strength for combating the poison. 

saline treat- Where peritonitis alone exists, especial reliance 

ment of *■ l 

peritonitis. [ s placed, in this day, upon the saline treatment. An 
early and thorough evacuation of the bowels, with 
discharge of flatus, should be obtained. The means 
employed may be the same as those above men- 
tioned, doses of Rochelle or Epsom salts being 
administered by mouth, or, if the stomach is not 
retentive, by rectal enemata. 



Fig 




Cradle for Supporting Bedclothes. 



Treatment 
for relief of 
pain. 



The pain arising from the tendency to accumula- 
tion of gas in the transverse colon and consequent 
pressure upon the diaphragm may be relieved by 
the application of warm flaxseed poultices over the 
lower portion of the chest, renewed once in two 
hours. 

The discomfort caused by the weight of the bed- 
clothing may be relieved by the use of a bed- 
cradle. 
Bed-cradie. A bed-cradle can be readily improvised by means 



MANAGEMENT OF COMPLICATIONS. 1 47 

of a large barrel-hoop divided in two equal parts. 
The two semicircles thus produced are then fast- 
ened together in the middle with their convexities 
looking the same way. This forms a coop-like ar- 
rangement, which, placed over the patient's body as 
she lies in bed, supports the bed-clothing quite as 
well as a more expensive cradle. 

Opium is but little used now in the management 
of peritonitis. The nurse would, however, think 
of using no remedy, unless the warm poultice, 
without the direction of the surgeon. The free 
use of salts has been found to afford speedy relief 
from pain. 

Internal Hemorrhage. — This may come about from internal 

J nemor- 

a slipping of the ligature, or from vessels which rha § e - 

have been severed by the breaking up of adhesions. 

The danger is greatest in the first day or two, pri- Primary 

mary hemorrhage occurring, as a rule, within 24 to \^l~ 

48 hours. 

The symptoms by which the nurse will recog- symptoms 

nize this condition are faintness, paleness, restless- rhal™ 01 " 

ness, a rapid, thready pulse. The surgeon should 

at once be sent for. The nurse can do' little for this Manage- 
ment. 

condition, excepting to keep the patient from faint- 
ing, by lowering her head and giving her stimu- 
lants in small doses, as 1 teaspoonful whisky or 
brandy in cold water once in 10 to 15 minutes, 



I48 DISEASES OF WOMEN. 

stimulating respiration by inhalation of hartshorn, 
etc., until the doctor comes. So far as possible the 
nurse should arrange to have everything in readi- 
ness should the doctor suddenly decide to reopen 
the abdomen. Especially should care be taken to 
see that a supply of hot sterilized water shall be in 
readiness, 
intestinal Intestinal Obstruction. — This may occur early or 

obstruction. . 

late after an operation. The intestines may from 
various causes be bent or constricted so as to pre- 
vent the passage of their contents beyond a cer- 
tain point. 

This obstruction may cause fatal collapse or even 
perforation of the intestines. 

o^obsteuc- ^he svm pt° ms are abdominal pain, constant 

tion. vomiting, distention of the abdomen, without a 

marked rise of the temperature. 

Prevention. Much may be done to prevent danger from this 
source, by proper attention to the bowels before 
operation. 

Methods of Chancre in the position of the patient from one 

relieving. 01 1 

side to another, or inverting the patient by elevat- 
ing the foot of the bed considerably above the sur- 
face, so that the intestines are carried toward the 
a n h injec * diaphragm ; the use of the high rectal douche, 
several quarts of water being allowed to flow into 
the intestines with the patient in an inverted 



MANAGEMENT OF COMPLICATIONS. I49 

position — any of these methods will sometimes 
straighten out the bend or loosen the constriction 
of the intestines. 

It has sometimes been found necessary to re- 
open the abdominal wound and thus to remove the 
obstruction. 

Fcecal Fistula. — This is a small opening in some p^tuL 
part of the intestines which communicates with the 
abdominal wound, opening on the surface of the 
body, and permitting the contents of the bowel to 
pass out at this point. These openings are pro- 
duced from various causes and are sometimes very 
slow to close up. 

The nurse must exercise the greatest care in 
changing dressings as often as may be necessary 
and preventing the contaminating effect of the 
faecal matter. 

Abscesses. — These may be suture-track abscesses, Abscesses. 
or may come in the abdominal walls at a point 
w T hence the drainage tube was removed, or may be 
formed by morbid changes in the pedicle. The Symptoms 

J *=» r ofinflam- 

nurse should be quick to report any redness or nation in 

x L J wound. 

irritation about the wound, as an abscess may thus 
be averted. When it once occurs, the abscess 
should be thoroughly evacuated and the dressings 
kept properly changed. 

Thrombosis. — By this is meant the formation of a Throm- 
clot in a vein, by which an obstruction to the 



150 



DISEASES OF WOMEN. 



Symptoms." 



Phleg- 
masia, 



circulation is produced. This causes a swelling of 
the limb. It is not an infrequent result after the 
removal of a simple ovarian tumor, particularly if 
it be a very large one. It is generally caused by 
the patient's attempting to walk or stand too soon, 
as at the end of a fortnight. In many of these 
cases a previous history of swelling of the limb can 
be obtained. Very frequently the patient simply 
complains that one leg feels bigger than the other. 
On examination the tissues over the tibia or shin- 
bone may seem swollen, but there will be no 
especial tenderness. 

Phlegmasia. — By this is meant an inflammation 
of the veins caused by a similar obstruction and the 
production of inflammation in the walls of the 
Symptoms, veins. The swelling in these cases is generally 
marked and extends to the thigh; enlarged, tender, 
cord-like veins may be felt in the groin, or under 
the knee, or elsewhere. There is apt to be con- 
siderable constitutional disturbance, fever, and 
severe pain. 

Whenever any sign of thrombosis occurs the 
patient should be kept in the recumbent position. 
The swollen limb should be kept warm by the 
application around it of cotton or wool. Over the 
swollen cord-like veins a warm flaxseed poul- 
tice may be placed for the relief of pain. The 
application on lint, beneath this poultice, of an oint- 



Manage- 
ment of 
thrombosis 
and phleg- 
masia. 



MANAGEMENT OF COMPLICATIONS. I 5 I 

ment, made by combining equal parts of belladonna 
and iodine ointment, will often serve to allay more 
quickly the swelling and pain. The limb should 
be elevated by pillows or a fracture box, forming 
an inclined plane. The bowels should receive 
careful attention, free purgation being obtained 
by any means the surgeon may prescribe. It is of 
extreme importance to keep the limb still, even 
after the swelling has subsided. The patient must 
not be permitted to place her foot on the ground 
until the surgeon gives his full consent, for this 
complication is a most serious one, and is a cause 
for anxiety. 

Pulmonary Embolism. — This is a fatal complica- Embolism. 
tion produced by a small clot being swept through 
the current of the circulation into the pulmonary 
artery, forming thus an obstruction to the circula- 
tion and producing instant death. Young, active 
patients, whom it is difficult to keep sufficiently 
quiet after an operation, are especially in danger 
from this cause. 

Cases have been reported where patients died 
suddenly from this complication days and even 
weeks after an operation, when all appeared to be 
going on well. It may occur, as a result of over- compiica- 
exertion, in any disease accompanied by debility 
or exhaustion. 

Parotitis. — Inflammation of the parotid glands, Pa 



tions. 



152 DISEASES OF WOMEN. 

such as occurs in mumps, is sometimes found as a 
complication after abdominal section. In some 
cases this is simply a temporary swelling which 
disappears in a few days ; in others it may be septic 
in character, when suppuration may result, or even 
inflammation of the periosteum and destruction of 
the lower jaw. The management, if septic, will be 
that of septicaemia — supporting in character. Such 
local applications for relief of pain, etc., must be 
employed as are ordered by the surgeon. 

Palpitation. Palpitation, — Severe attacks of palpitation are 
apt to occur after abdominal section, and most fre- 
quently occur at night. It is supposed that these 

Causes. are caused by changes in the circulation, due to 
removal of a tumor, and, possibly, in large part to 
enforced lying on the back for considerable length 

Manage- of time. A half teaspoonful of aromatic spirit of 

ment. A L 

ammonia in two tablespoonfuls of water will give 
the patient great relief. The symptom may greatly 
alarm an inexperienced nurse, but any expression 
of fright on her part only makes the patient worse, 
hence she should not allow her anxiety to be seen. 
The condition is not a dangerous one. 

Cystitis. Cystitis. — Inflammation of the bladder quite fre- 

quently occurs as a complication after abdominal 

Symptoms, section. The patient complains of pain in the 
lower part of the abdomen, and feels cutting pains 
on passing her urine. Sometimes the irritation 



MANAGEMENT OF COMPLICATIONS. I 53 

shows itself simply in a frequent desire to pass 
water. The urine is generally thick with ropy 
mucus and contains a considerable amount of sedi- 
ment. The difficulty of passing water in urinals or Causes, 
bedpans in the recumbent posture is partly 
responsible for this. The more frequent cause is 
improper catheterism. The awkward use of the 
catheter, which leads a nurse to carry discharges 
from the vagina into the urethra and bladder ; or 
the use of a catheter which is not aseptic, not hav- 
ing been kept properly cleansed, are prominent 

causes for such trouble. The free use of flaxseed Manage- 
ment. 
tea or barley water, with a stoppage of the use of 

the catheter, will often be sufficient to put a stop to 

the suffering. The use of medicinal remedies in 

case of too great acidity or alkalinity of the urine 

will have to be directed by the surgeon. The nurse ^e. ngof 

should have a little litmus paper, which can readily 

be obtained at any apothecary's, and test the urine, 

so that she can report its reaction to the surgeon. 

If the blue litmus paper is turned a decided red 

when dipped in the urine, the secretion is too 

acid; if the pink litmus be turned blue we have 

an alkaline urine. 

It is sometimes necessary, for the comfort of the Washing 

patient, to wash out the bladder with some soothing bladder. 

solution, as a saturated solution of boric acid. The 

apparatus necessary for this is simply a soft rubber 



154 DISEASES OF WOMEN. 

Nelaton catheter, a small funnel which can slip into 
its outer end, and a small pitcher containing the 
solution to be used in the process. The solution 
should range in temperature from ioo°-io5° Fahr., 
not higher. The patient being placed on the pan, 
the urine contained in the bladder is first entirely 
drawn off by means of the catheter; its outer 
extremity is then elevated, the funnel fitted in and 
the solution gently allowed to flow into the bladder 
until the patient experiences a sense of distention 
of the bladder ; the funnel may then be inverted 
over the bedpan, and the liquid allowed to flow 
out. This cleanses the bladder of all debris. It 
may then be refilled to distention, and again emp- 
tied so long as the liquid does not come away clear. 
After the liquid becomes clear, the bladder may be 
refilled with the solution and the catheter with- 
drawn, allowing the solution to remain in the 
bladder for its medicinal effect upon the inflamed 
mucous membrane. The patient will probably 
retain this some little time before passing it. 
Return The return or double-channel catheter is some- 

times used in preference to the apparatus just 
described, but in my opinion is not so convenient. 
The nurse should never attempt washing out the 
bladder without the surgeon's instruction and sanc- 
tion. 

Occasionally the nurse is directed to place warm 



catheter. 



MANAGEMENT OF COMPLICATIONS. I 55 

flaxseed poultices over the lower part of the abdo- Poultices 
men for the relief of the bladder irritation. This pain, 
cannot always be resorted to, because of the close 
proximity of the wound to the part. Should the 
poultices be ordered, the nurse should see that 
they are changed with sufficient frequency to keep 
therh warm, as they are worse than useless when 
cold. A poultice of ordinary size, if well covered 
with oiled silk and a layer of cotton or w r ool, will 
retain its warmth about two hours. 

Tetanies. — This is a disease which consists in a Tetanus. 
permanent contraction of all or some of the muscles. 
Its characteristics are closure of the jaws, difficulty 
or impossibility of swallowing, rigidity of the limbs 
and trunk. The trunk is sometimes curved for- 
ward (emprosthotonus), sometimes backward (opis- 
thotonus), and sometimes to one side (pleurotho- 
tonus). 

When tetanus is confined to the muscles of the Trismus. 
jaws it is called trismus. 

It is a most formidable condition. This disease, 
although rare after abdominal section, may occur, 
as after other operations. 

Treatment is of little avail. It must be treated Treatment. 
here as where it complicates other diseases, that is 
by blood-letting, cold and warm bathing, anaesthe- 
tics, opiates, etc., according to the surgeon's direc- 



1 5 6 



DISEASES OF WOMEN. 



Passage of 
ligatures. 



Menstrua- 
tion after 
abdominal 
section. 



Necessity 
for rest. 



tion. The nurse's duty is to report the first indica- 
tions of such an occurrence. 

The surgeon may desire to reopen the abdomen 
for examination of the stump for any special source 
of irritation. 

Passage of Ligatures. — When the pedicle of the 
tumor suppurates, the ligatures may be discharged 
through the bladder, or through the bowels, or 
through an abscess of the abdominal wall. This 
may occur at varying lengths of time after the 
operation. 

Menstruation after Abdominal Section. — A "show" 
of blood frequently occurs a few days after opera- 
tion, particularly after ovariotomy or operation 
upon the uterine appendages. There is almost 
always some rise in temperature accompanying 
this " show " and frequently depression of spirits. 
The pulse, too, may rise considerably. 

The patient must always be advised to keep very 
quiet during the first three or four periods after an 
abdominal section, particularly for disease of the 
pelvic organs, as there may be hemorrhage from 
the stump. 



CHAPTER XIII. 

THE PELVIC ORGANS IN WOMEN. 
These are divided into the external and internal External 

and mter- 

organs of generation. The external organs are J^-* 6111 " 
also called the " pudenda" or " vulva." 

Immediately above the pubic bone, or anterior 
border of the pelvis, is a cushion of fat, usually 
covered with hair. This is called the " mons ve- Mons 

veneris. 

neris." 

On each side of the opening of the vulva are the 
labia majora, or large lips. Lying beneath these La1 ? ia 

J ' q r J c> majora. 

and concealed by them in young women, are two 
thin folds of flesh, named the " labia minora " or 
"nymphae." They join together above, and at Nymphae. 
their junction is a small projecting body called the 
ii c Htoris." Clit0ris - 

The small triangular space between the clitoris 
and the nymphse is the vestibule. Vestibule. 

The opening of the urethra (the " meatus urina- Meatus 
rius "), through which the urine escapes from the 
bladder, is in the middle of the lower border of the 
vestibule. 

It is very important that the nurse should know 
157 



unnanus. 



Vaginal 
orifice. 



158 



DISEASES OF WOMEN. 



the exact position of the meatus urinarius, as she 

will frequently be called upon to pass the catheter. 

Below the vestibule is the orifice of the vagina, 



Fig. 44. 




S^ .-«- 



I. The right large lip. 2. The fourchette. 3. Right nympha. 4. 
Clitoris. 5. Urethral orifice. 6. Vestibule. 7. Orifice of va- 
gina. 8. Hymen. 10. Mons veneris. 1 1. Anal orifice. 

the canal leading to the uterus or womb. In vir- 
gins a delicate membrane, usually crescentic in 
shape, blocks the entrance to the vagina. 



THE PELVIC ORGANS IN WOMEN. 1 59 

The hymen is usually ruptured at marriage, but Hymen. 
a woman may be a virgin, yet have no hymen. 
In some cases it persists even after marriage and 
offers an obstruction at childbirth. A woman who 
has borne children has a few fleshy projections at 
the orifice of the vagina, the only remains of the 
hymen, called the " carunculae myrtiformes." Be- m y™r_ cul2e 
tween the vulva and the anus is a mass of flesh, formes - 
the space on the surface measuring \y 2 inches in 
length. During the birth of the child this becomes 
greatly distended, and thins like rubber. This is Perineum. 
the perineum. It may be torn during labor to a 
greater or less extent ; sometimes it is completely 
torn into the bowel. 

That part of the perineum in the virgin which 
forms the posterior border of the vulva, is called 
the " fourchette." It is merely a fold of skin, and Fourchette. 
is almost always torn in a first labor. 

Behind the perineum is the anus, or orifice of £ nalori - 

r ' fice. 

the rectum — the lower part of the bowel. 

The vagina is a canal connecting the external Vagina. 
with the internal organs of generation. 

The uterus is at the top of the vagina. In front Uterus - 
of the uterus is the bladder, and behind and to the 
left, the rectum. 

A secretion of mucus keeps the vagina moist. 
There should, however, be no discharge in a per- 
fectly healthy woman. During pregnancy, and as 



l6o DISEASES OF WOMEN. 

a result of ill-health or local inflammation, the nat- 
ural secretion may be greatly increased, and the 
patient is then said to have " the whites." 

In labor the discharge is very greatly increased, 
so as to aid the birth of the child. 

The uterus is a pear-shaped organ, 3 inches in 
length, 1 y 2 inches in breadth, and about 1 inch in 




Cavity of the Uterus and Fallopian Tubes. 
A. Superior border or fundus of the womb. B. Cavity of the 
womb. C. Cavity of the neck of the womb. D. Canal of the 
Fallopian tube. E. The fimbriated extremity. F, F. The ovaries. 
G. The cavity of the vagina. 

thickness. It weighs a little over an ounce in its 
normal condition in a virgin. After child-bearing 
it remains larger and heavier than before. That 
portion of the uterus which communicates with the 
Cervix. vagina is called the neck, or cei'vix. The chief por- 
tion of the organ above this is called the body, and 



THE PELVIC ORGANS IN WOMEN. l6l 

the rounded upper surface the fundus. The open- 
ing in the cervix which communicates with the va- 
gina is called the "os uteri." That portion of the Os uteri. 
cervix in front of the os uteri is the anterior lip, 
while that part which lies behind is the posterior 

up. 

The Fallopian tubes are two canals which pass Fallopian 

L x tubes. 

from each side of the upper portion of the uterus. 
They are from 3 to 4^ inches long and will admit 
the passage of a bristle. 

Each ends in a trumpet-shaped opening sur- 
rounded by a fringe of small projections called 
" fimbriae." This is called the fimbriated extremity. SSSt^ 
When the ovum (or egg) escapes from the ovary, 
it is received by the Fallopian tube and reaches the 
cavity of the uterus in this way. 

The ovaries are two small flattened bodies about Ovaries. 
an inch long and half an inch thick. They lie 
about an inch from the fundus of the uterus on 
each side, in the folds of the broad ligament. The £ r °^ d ents 
broad ligaments are folds of peritoneum, a thin 
glistening membrane which covers the uterus and 
all the pelvic organs, and by means of which the 
uterus is suspended in the pelvis. The bladder 
and rectum being covered with the same tissue, 
there is an intimate connection between the three, 
so that if one is deranged the others are likely to 
be so also. 
11 



l62 



DISEASES OF WOMEN. 



Breasts. 



Menstrua- 
tion. 



Puberty. 



The breasts are considered as belonging to the 
external organs of generation. They are two 
glands situated on the front of the chest, one on 
each side of the breast-bone. They vary in size 
and shape in different women, and during preg- 
nancy they enlarge greatly. 

They secrete milk for the nourishment of the 
child. The nipple at the apex of the gland is a 
conical-shaped projection. The milk ducts all come 
towards it from the different parts of the breast and 
open on its surface. The areola is a pink or brown 
circle which surrounds the nipple. 

There is an intimate connection between the 
breasts and the uterus. Pain in the breast may be 
the result of disease of the uterus. The secretion 
of milk is called " lactation" 

Menstruation is a bloody discharge from the 
uterus every month. It begins usually about the 
age of fourteen and recurs every month except 
during pregnancy or while a woman is nursing. It 
ceases at the change of life or menopause (between 
forty-five and fifty). 

At puberty, that is when this function first appears, 
the girl becomes a woman, the breasts enlarge and 
the pelvis increases in size. The organs of gene- 
ration become ready to perform the functions of 
reproduction. 

The menstrual flow recurs every twenty-eight 



THE PELVIC ORGANS IN WOMEN. 1 63 

days and lasts about four days. The quantity of Periodicity 

. . . . * . r r . * of menstru- 

blood lost at a period is from lour to eight ounces, aifw. 
Different women vary much in this respect. The 

\ L Quantity of 

discharge is blood mixed with mucus. Its color is menstrual 

. . , flow - 

dark red. Any peculiarity in color or the appear- 
ance of any clots in the discharge will need to be 
noticed by the nurse, and the discharge kept for 
the doctor's inspection. There is usually a feel- ^y^' g 
ing of discomfort at the menstrual period, with s > Tm P toms - 
headache, pains in the back, breasts, etc. These 
symptoms are more severe in some women than in 
others. 

Conception most usually takes place immediately £°" cep " 
or very soon after a period. This is not an invari- 
able rule, as women have become pregnant before 
menstruation has been established or even after the 
menopause. They may also become pregnant 
while nursing. 

A nurse is so often questioned on these points 
that it is well for her to have information concern- 
ing them. Always endeavoring to discourage the 
inquisitiveness of mere prurient curiosity, she 
should aim to give wise counsel concerning matters 
of which her patient may hesitate to speak to her 
physician. In doing so, the nurse should, however, 
speak to the physician of any matters of import- 
ance concerning the condition of the patient, which 
she may thus learn, and ask his counsel as to the 
advice she should give. 



CHAPTER XIV. 



DISEASES OF WOMEN. 



Definition. 



Causes of 
disease. 



By this term is meant, in particular, the diseases 
affecting the organs peculiar to women, as the 
external and internal genitals. The term may be 
made to include diseases of the rectum and bladder, 
which are closely associated with these organs, 
and also diseases of the breasts. 

In investigating the causes of pelvic disease, 
we find that ignorance on the part of women, is 
largely responsible for their great number and fre- 
quency of occurrence. Civilization, so called, 
has laid certain restrictions on healthful living and 
established fashions which are directly opposed to 
physiological laws, and which tend to produce 
abnormal conditions. 

Some of the most common causes of pelvic 
diseases are — 

I. Neglect of physical exercise, especially in the 
open air. 

*2. Improper clothing. 

3. Improper and insufficient food. 
164 



SUGGESTIONS IN HYGIENE. 165 

4. Habitual neglect of the functions of the 
bowels and bladder. 

5. Imprudence during menstruation. 

6. Overstrain of the nervous system by too 
much excitement, unwholesome reading, unwhole- 
some companions, unwholesome thought. 

7. Marriage when disease of the genital organs 
exists. 

8. Lack of prudence in the marital relations. 

9. Prevention of conception. 

10. Induction of abortion. 

11. Neglect of injuries due to parturition or child- 
birth. 

Within recent years it has become more cus- Lack of 
tomary for women to take physical exercise : girls Llrdse, 
may play tennis, row, ride on horseback, and take andfresi 
long walks, without being regarded as unlady-like. 

Even yet, however, so much of woman's work 
lies within the walls of her home that she is apt to 
become careless on this point, to lose all taste for 
out-door exercise and to confine herself to heated, 
illy-ventilated rooms. For amusement she takes 
up reading, music, drawing, or some other light 
task, which keeps her sitting, so that her muscular 
system becomes weakened. It is not only bodily 
exertion, however, that she needs, but the exhila- 
rating effect of sunlight and fresh air — the mental 
relaxation which comes from out-door exercise. 



air. 



1 66 DISEASES OF WOMEN. 

Every healthy woman should walk at least two 
miles daily and observe the manner of walking 
which will serve to exercise her muscles to their 
fullest extent and thus stimulate the circulation — a 
brisk walk with the head held erect and the shoul- 
ders thrown well back, so that the lungs may, at 
the same time, be well filled with air. So import- 
ant is it to keep the general circulation in good 
condition that in the management of conditions of 
local congestion or inflammation which interfere 
with active exercise, the use of passive motion by 
the Swedish movement cure, massage, Turkish 
baths, or frequent salt baths combined with calis- 
thenics are much resorted to in treatment. 
improper In the style of clothing worn by women the 
last few years have made a great change. It is no 
longer necessary for a woman to dress injuriously to 
health in order to be well dressed. The patterns 
of the Jenness-Miller Reform Dress Wear and 
other dress reform systems aim to correct former 
unhygienic requirements. The constriction of the 
chest caused by the use of corsets ; pressure and 
partial paralysis of the abdominal and chest muscles 
by tight and heavy clothing ; the unnatural position 
of the pelvic organs as a result of such pressure, 
were the inevitable result of former fashionable 
modes of dressing. To a certain extent these 
deleterious styles still prevail, and women who are 



clothing. 



SUGGESTIONS IN HYGIENE. 



167 



ignorant of physiological laws, by adopting such 
fashions keep them up. Intelligent women who 
desire to live long and happily, and to provide a 
future of physical comfort for their children, are 
ready to adopt the reform systems which correct 
these errors. 

The clothing should all be supported from the Hygienic 

dressing. 

shoulders, and should be so constructed as to 

Fig. 46. 




Equipoise Waist. 



allow perfect freedom of every part of the body. 
The use of the Jenness-Miller model bodice or 
Equipoise waist — to which the skirts and under- 
garments may all be fastened, is an excellent 
method of attaining this purpose. The jersey- 
fitting union undergarment of silk or merino may 
be worn in addition, if desired. Divided skirts or 
leglettes made of muslin or, in winter, of flannel, 



1 68 DISEASES OF WOMEN. 

cashmere, or silk, etc., make a very comfortable 
undergarment and enable one to dispense with 
underskirts. The skirts of dresses may be fast- 
ened, by means of buttonholes in the waistband, to 
the Equipoise waist or model bodice. If heavy, 
however, it is best to have them fastened to a 
separate waist, modeled after the pattern of the 
child's petticoat waist with armholes. Were these 
methods more strictly observed in the dressing of 
growing girls, fewer women would be found suffer- 
ing from displacements of the uterus and ovaries 
and the many pelvic diseases which follow in their 
wake. 
improper Poor blood as a result of poor eating is so com- 

and insuffi- x ° 

dent food, mon an accompaniment of uterine disease that we 
must often regard it as the chief cause of the ab- 
normal condition. The muscular tone of the pel- 
vic organs is decidedly affected by want of sufficient 
nutrient material, and displacements are thus readily 
produced. It is not only important that a certain 
amount of food shall be taken daily, but the food 
should be such as is capable of making blood of 
good quality. It should be nourishing and digest- 
ible. Pastry and sweets should be avoided or taken 
only in small amount. The meals should be so 
regulated that a heavy meal shall not be taken at 
night when the digestive processes are least active. 
Milk, eggs, meat, bread, fresh vegetables and fruit 



SUGGESTIONS IN HYGIENE. 1 69 

should be properly combined in forming a whole- 
some dietary. 

Habitual constipation and lack of attention to Habitual 

1 neglect of 

the bladder are frequent causes of uterine displace- thefunc- 

1 x tions of 

ment. The uterus lying, as it does, between the b° a ^er and 
bladder and bowel is readily affected by the condi- 
tion of either. Not realizing this, women are often 
led, from motives of modesty, to neglect attending 
to their demands, and thus they acquire a habit of 
toleration which is most injurious. The large hard 
masses of fecal matter which remain not only for 
days, but often for a week at a time in the rectum, 
interfere with the circulation in the pelvic organs, 
and produce displacements which are sometimes 
most unmanageable, in fact, incurable. A full 
bladder acts similarly by pressure on the anterior 
surface of the uterus, and, in addition, the retention 
of urine may become a source of disease both of 
the bladder and of the kidneys. 

Violent or excessive physical exercise is to be imprudence 
avoided during menstruation ; because of the con- menstrua, 
gested condition of the pelvic organs at this time. 
For the same reason precaution should be taken 
regarding undue exposure to cold, or sudden chill- 
ing from imprudence in bathing. The suppression 
which is often thus induced is a result of over- 
congestion and a direct cause of uterine and ovarian 
disease. Excessive emotion frequently produces 



170 



DISEASES OF WOMEN. 



Nervous 
overstrain. 



Marriage. 



similar results. Hence scenes of excitement should 
be avoided at such times. Exposure due to insuf- 
ficient clothing, the low neck and bare arms of 
fashionable evening dress, have frequently been the 
cause of life-long ill health. 

Tension upon the nervous system is partly the 
result of our fast modes of living — the competition 
of the day which makes each one strive to surpass 
his neighbor. It is also largely the result of in- 
heritance, education, and habit. This unfortunate 
combination of circumstances offers a formidable 
resistance to one's efforts to gain self-control. 
Determination and continued effort, however, ac- 
complish much in the formation of habits which 
give one a capacity for endurance. The diversion 
of the mind into wholesome trains of thought and 
study will serve to hold in abeyance the impulses 
of one's nature. Sources of excitement, such as 
persistent novel-reading, a frequenting of places of 
amusement, extreme indulgence in society gather- 
ings, are to be avoided. 

One of the greatest difficulties a nurse will meet 
will be the management of a mind thus diseased, 
and infinite tact and skill will be necessary to 
enable her to steer the thoughts and purposes of 
her patient into safe channels. The nurse must 
make the moral atmosphere of the sick-room. 

Marriage when disease of the genital organs 



SUGGESTIONS IN HYGIENE. 171 

exists is another frequent source of disease. The 
reason for this may clearly be seen. Organs 
already the seat of a morbid process are only more 
extensively irritated by the increased congestion 
thus induced. 

Lack of prudence in the marital relations in a p^nce 
similar way may cause disease. Periods during 
which the pelvic organs are in a state of congestion 
from natural or abnormal causes, should be periods 
of rest. Thus during the menstrual period and 
for a short time before and after the same, during 
pregnancy and the lying-in, the pelvic organs 
demand rest. 

Prevention of conception and induction of abor- Prevention 

*■ 01 concep- 

tion act in the same way as the last two causes tion - 

mentioned, that is, they result in conditions of 

excessive congestion and even active inflammation 

which not only bring about diseased conditions 

which cause much suffering, but which endanger 

the life of the patient. Blood-poisoning is not an 

uncommon result of efforts at inducing abortion. 

Neglect of injuries due to childbirth is a most induction 

. .of abortion 

common cause of disease. Lacerations, erosions, injuries 

due to 

etc., frequently pass unnoticed by the physician, child-birth. 
The nurse in cleansing her patient after delivery, 
has an opportunity to observe them, and should be 
careful to call the attention of the physician to their 
existence. This should always be done elsewhere 



172 DISEASES OF WOMEN. 

than in the presence of the patient. The best time 
to repair these injuries is as soon as possible after 
their occurrence. Should their repair for various 
reasons be put off for a time, they should not be 
forgotten, but the advice of a competent physi- 
cian obtained as to the probability of their inducing 
chronic forms of pelvic disease. 



CHAPTER XV. 

GENERAL NURSING IN PELVIC DISEASES. 

From what has been said in the preceding chap- 
ter it will be seen that it is seldom that a nurse will 
be called upon to take charge of a case of pelvic 
trouble, that she will not find the patient suffering 
from many morbid conditions. She will have poor 
blood, poor circulation, poor appetite, poor diges- Symptoms 
tion, poor nerves. She will suffer from cold hands' ^Lease! 
and feet, indigestion, constipation, headache, back- 
ache, sleeplessness, and extreme nervousness. The 
nurse will have abundant opportunity to ex- 
ercise all that ingenuity and skill can devise to meet 
this array of ills. 

The physician's directions will include — 

1. Attention to diet. 

2. Stimulation of the circulation and respiration Mana e _ 

by bathing, exercise, etc. ment - 

3. Regulation of the sleep. 

4. Regulation of the functions of the body. 

5. Regulation of the clothing. 

6. Treatment of local conditions of disease. 

7. Mental occupation. 

173 



Milk diet. 



174 DISEASES OF WOMEN. 

Forced The patient will probably be placed upon " forced 

feeding; " that is, she will be made to take a cer- 
tain amount of nourishment in the twenty-four 
hours. The food will be prescribed by the physi- 
cian according to the especial requirements in each 
case. The milk diet is frequently used where 
digestion and assimilation are poor. Beef-tea is 
sometimes used, alternating with milk ; a gill or a 
gill and a half of each may be given once in two 
hours. It may be necessary to have these pepton- 
ized. Should the liquid milk diet tend to produce 
flatus it may be of advantage to thicken the milk 
with rice flour, wheat flour, crumbed bread, etc. ; 
junket, or milk thickened with rennet, is often 
liked by many patients, and is easily digested ; 
farina, wheat germ, egg custard, and similar prepa- 
rations, if well prepared, may be quite readily di- 
gested and help to vary the monotony. The chief 
objection to the milk diet arises from its monotony ; 
the patient gets to dislike it, so that it is almost im- 
possible to get her to take sufficient nourishment. 
By a little management the nurse can put off this 
period. A drop of black coffee, or extract of va- 
nilla in a glass of milk, or a little salt, will so change 
the flavor as to make it more palatable. The addi- 
tion of lime water, a tablespoonful or two to a glass 
of milk (i}4 gills) is sometimes necessary to aid the 
digestion. 



GENERAL NURSING IN PELVIC DISEASES. 1 75 

Where the patient does not need to be kept on Mixed diet, 
liquid food, or when the dietary can be increased, 
fresh animal food can be given three times a day, 
and as much other nutritious food as the patient 
can take — stale bread, rice, eggs, crushed wheat, etc. 
Between breakfast and dinner, dinner and supper, 
and on retiring at night, the patient should take a 
tumblerful of milk or a cup of beef- tea, or of beef, 
mutton, or chicken broth. 

Should the patient be entirely on liquid diet she Night 
should receive nourishment about once in three 
hours through the night. 

A very anaemic patient may need to be fed once 
or twice through the night, even when taking a 
mixed diet. 

Where meats are not well digested, it has been 
found, in our experience, that the raw-beef sand- hf™* 1 
wich, made by scraping a tender piece of raw 
beefsteak with a knife, salting and spreading the 
pulp thus obtained between thin slices of bread or 
toast, offers a convenient and palatable form of ad- 
ministering animal food. Beef being the most nu- 
tritious of the animal foods, a tender piece of broiled 
beefsteak, or a slice or two of rare roastbeef, or the 
raw-beef sandwich, should frequently form a part of 
the meal. All fried foods, pastry, and sweet des- 
serts should be avoided. When the stomach is 
very irritable, and only small quantities of food can 



176 



DISEASES OF WOMEN. 



Stimulation 
of skin. 



Exercise. 



Rules for 
exercise. 



be taken, freshly expressed beef-juice gives a highly 
concentrated and nutritious food, 1 tablespoonful 
of this representing the nutritive properties of about 
one-quarter of a pound of beef. 

Bathing. — A sponge bath of warm water strongly 
impregnated with salt should be taken each morn- 
ing on rising, and, if possible, at night on retiring. 
A teacupful of ordinary table salt may be added to 
the basin of warm water. Rocksalt may be ob- 
tained for bathing purposes, and kept on hand if 
preferred. This sponging should be followed by 
a brisk rubbing with a coarse towel ; the knitted 
tape-towel is the best, or a bathing glove of coarse 
material, or a flesh brush may be used. 

Calisthenic exercises with dumb-bells, rods, etc., 
or the practice of Swedish movements from ten to 
fifteen minutes following each bath, are of great 
value. 

Any active exercise to be taken by the patient 
must be controlled by the physician. If the pa- 
tient is unable to take such, the use of massage 
and tonic electricity will be called into play. A 
good nurse should understand the methods of 
applying both massage and electricity for their 
tonic effect. Neither should be given within two 
hours of a full meal, either before or after. Neither 
should be given when the patient is very tired, nor 
should the application be made to exhaustion. An 



GENERAL NURSING IN PELVIC DISEASES. \JJ 

hour's massage is the average length of time for a 
patient who has learned to take it without growing 
tired. The application of electricity, that is by Electricity. 
means of the faradic battery, will require from 
twenty minutes to half an hour for the entire body. 
The patient should be kept well protected from ex- 
posure during these applications. 

A patient who is entirely dependent upon passive 
exercise and who is not too weak, may have one of 
these applications in the morning and the other in 
the afternoon or at bedtime. When the patient 
suffers from sleeplessness, the massage given at Massage. 
bedtime has often a most calming and healthful 
effect, serving to induce sleep. In any case, at 
whatever time of day these applications may be 
given, the patient should remain quietly at rest in 
bed for a half an hour to an hour after the treat- 
ment, and if possible take a nap. 

Sleep. — A patient in this generally run-down Sleep, 
condition demands a great deal of sleep, and should 
try to obtain at least nine hours every night, beside 
the hour in the daytime. The habit of retiring 
early should be cultivated, as sleep is far more 
refreshing when thus taken in the early hours of 
the night. The patient should be asleep at least 
by nine o'clock. She will then be prepared for 
early rising and the enjoyment of the hours of the 
day which are most invigorating. 



178 DISEASES OF WOMEN. 

Clothing. — Something of what is required in this 

connection has already been stated in the preceding 

Rules chapter. The clothing should be loose, light, and 

regarding r fa > & > 

clothing, supported from the shoulders. It should also be 
sufficiently warm to aid in keeping up the warmth 
of the surface of the body. Sudden changes in the 
atmosphere should be provided for, and additional 
clothing employed to protect from chilling. 

Remedies prescribed by the physician should be 
carefully given and their effect upon the functions 

Function of the body observed and noted. The bowels 

of bowels. 11111 11 1 

should be thoroughly evacuated once in twenty- 
four hours. If this is not a free movement, or if 
its passage is attended with difficulty, bringing 
about straining, the matter should be reported. 
The use of some saline water, as Hunyadi Janos, 
a half tumblerful once or twice daily, and the 
proper use of massage over the abdomen in the 
daily treatment may bring about a permanent cure 
of this trouble. The color and consistency of the 
movements should be likewise observed. 
Function The quantity of urine passed in twenty-four 

of kidneys. 

hours should be noted. The usual amount in 
health is between forty and fifty fluid ounces. It 
may rise as high as eighty fluid ounces. The vari- 
ation depends greatly upon the amount of fluid 
taken. The urine may be scanty when the 
patient has abstained from liquids, or when water 



GENERAL NURSING IN PELVIC DISEASES. 1 79 

has been eliminated in excess by skin or bowels. 
Thus free sweats or a persistent diarrhoea will 
greatly affect the quantity of urine passed in one 
day. Any diminution of the urine which ap- 
proaches suppression is of grave import and should 
be promptly reported. Temporary excess in the 
flow of urine will occur after hysterical paroxysms 
and other convulsive attacks. The color, quantity, 
reaction, and presence or absence of sediment 
should be noted. 

Any disturbance of the digestion must be care- Distur ]?- 

J & ance of 

fully reported to the physician, as it is exceedingly di s estion - 
important that digestion and assimilation should do 
their part to restore the broken-down system. 

Vaginal Injections. — The treatment of conditions 
of disease of the pelvic organs very frequently 
calls for the use of vaginal injections. 

Various methods have been suggested for giving Methods of 

00 o o giving 

these, and several different forms of vaginal syringe -^j-J^ 
have been invented. The Davidson hand-ball 
syringe, or the Davidson fountain syringe, are 
those probably most frequently employed. The 
method as described by Emmett, who was the first 
gynaecologist in this country to employ such 
douches extensively in his practice, is as follows : — 
" The injection can be better given to the patient 
after she is undressed for the night, and in bed. 
She should be placed near the edge of the bed, 



i8o 



DISEASES OF WOMEN. 



with the hips elevated as much as possible by the 
bedpan, and a small pillow under her back, the 
lower limbs being flexed. 

" Her body must be covered, to protect her from 
cold and her position made perfectly comfortable ; 
whenever the bed is a soft one, for the purpose of 
keeping the hips elevated a broad board should be 




Y-^-WT ■£. S.50ns 



Fountain Syringe. 



placed under the pan to prevent it from sinking 
into the bed from the weight of the patient. The 
vessel of hot water is placed on a chair by the bed- 
side, and the nurse passes the nozzle of the syringe 
into the vagina, over the perineum, directing it 
along the recto-vaginal wall (that is, the posterior 



GENERAL NURSING IN PELVIC DISEASES. l8l 

wall of the vagina), until it reaches the posterior 
cul-de-sac (the portion of the vagina back of the 
neck of the womb). 

"The water must be thrown in at first very care- 
fully, until the vagina has become distended." 

In place of the interrupted stream used by work- 
ing the hand-ball syringe, as described in this 
method, the fountain syringe, the resefvoir of which 
should be hung several feet above the patient's 
head, may be employed to even greater advantage, 
as it permits a continuous stream to flow into the 
vagina, and does away with the danger of the 
introduction of air or the forcible injection of 
water into the uterine cavity in cases where the 
uterine os has been torn. 

In private practice and in the absence of a nurse, 
the patient is often dependent upon herself for this 
treatment, hence she should be taught how to 
arrange for this. Dr. T. G. Thomas, of New York, 
suggests the following plan : " The patient places 
a pillow upon the edge of her bed, and an empty 
tub upon the floor under it. She then covers the 
pillow by a piece of india-rubber cloth which 
drapes into the tub. Then putting two chairs, one 
on each side and a little in front of the tub, she 
places a small table in front of these, and upon this 
another chair. Upon the chair which stands on 
the table a tub containing about two gallons of hot 






1 82 DISEASES OF WOMEN. 

water is now put, near the bottom of which has 
been inserted a spigot to which a long rubber tube 
is affixed, which ends in a vaginal nozzle. The 
patient now lies upon the bed, the pelvis elevated 
by the pillow, places her feet upon the chairs, cov- 
ers her limbs with a shawl or blanket, touches the 
spring — an ordinary clothes-pin makes a good one 
— which controls the flow, and the water bathes the 
vagina and running out is conducted by the india- 
rubber cloth into the tub. Here the only articles 
purchased are the tub with the spigot and tube 
attached, and a yard of india-rubber cloth, which 
are inexpensive." 
special i n our own practice in the hospital wards we 

apparatus. L L 

are accustomed to using, as a reservoir for the 
water, a large copper kettle which holds several 
gallons of water, called the douche-can. A spigot 
with rubber tubing is attached to the lower part of 
this. A rubber bedpan with inflated border and 
outlet tubing, as shown in the cut, is employed, 
being placed on the edge of the bed upon a board, 
if the bed be yielding. It is well to protect the bed- 
ding beneath by means of a piece of rubber cloth. 
This may be long enough to drape down over the 
edge of the bed and be spread out upon the floor, 
the waste bucket being placed on it. The patient 
lies with the bedpan adjusted under her, a pillow 
placed beneath her back to give it support. The 



GENERAL NURSING IN PELVIC DISEASES. 1 83 

douche-can filled with hot water, to which any 
medicinal agent may be added, as directed by the 
physician, is placed upon a high stand, or on a 
stool or box placed on a table at the head of the 
patient's bed ; the spigot being turned and the va- 
ginal nozzle attached to the tubing properly ad- 
justed, the water flows into the vagina and thence 
into the rubber pan. Overflow is prevented by the- 

Fig. 48. 




LEUTZ&5QNS 
Rubber Bedpan. 

water emptying into the waste bucket through the 
outlet tubing. 

A form of syringe, which enables the patient to 
do without a bedpan, has recently been devised. 
It is known as the Gordon Utero-Vaginal Irriga- 
tor. . The nozzle is adjusted near a bulb, which is 
intended to fit into the vaginal orifice, and thus ob- 
struct the return flow from the vulva. An outlet 
of metal is connected with this bulb, and to it a 



1 84 



DISEASES OF WOMEN. 



long piece of rubber tubing is attached, which com- 
municates with a waste bucket. The patient lies, 
as before described, on the edge of the bed, with 
her limbs drawn up, a piece of rubber cloth beneath 
her hips. The reservoir containing the water to be 
used is placed at the head of the bed, elevated some 

Fig. 49. 




Utero-Vaginal Irrigator. 



distance above the level on which the patient lies. 
The tubing from the reservoir is connected with the 
receiving pipe of the bulb. Through this the water 
passes into the vagina, and is carried away by the 
outlet pipe and tubing. The bulb should be air- 



GENERAL NURSING IN PELVIC DISEASES. 1 85 

tight, for unless fully distended the water will es- 
cape through the vulva from around it and the 
value of the apparatus will be destroyed. The size 
of the bulb will of necessity have to correspond to 
the size of the vulva. This syringe, when it works 
well, is not only of advantage as doing away with 
the bedpan, but will enable the douche to be taken 
at a much higher temperature than ordinary, for 
the water does not flow over the skin on its exit 
from the vulva, which is far more susceptible to the 
effect of heat than is mucous membrane. A tem- 

Fig. 50. 




Vaginal Nozzle with Reverse Current. 

perature of from I20°-I25° Fahr. can thus read- 
ily be borne. The nozzle of a vaginal syringe 
should have no opening at its extremity, but should 
be made so that a reverse rather than a direct cur- 
rent may be obtained. 

Where vaginal injections are intended for medi- Position in 

J which vagi- 

cinal effect it is best that they should be taken jaiwjec- 

J tions are 

lying down. In no other way can the water be- taken - 
carried so effectually to the diseased parts. When 
required only for cleanliness they may be adminis- 



1 86 DISEASES OF WOMEN. 

tered in the upright posture, the patient being 
seated over a vessel. A convenient method is that 
of placing in a tub the water to be used — one or two 
gallons. The patient may seat herself over this on 
a board placed across it, or upon a stool placed in 
it, and inject the water by means of a hand-ball 
syringe. The long nozzle being used, the water 
may be thus made to bathe the cervix. When 
pessaries are worn, a daily cleansing injection is 
essential. 
The The Tampon. — Many pelvic maladies are treated 

tampon. * J L 

by the use of the tampon, or pledget of cotton or 
wool saturated or anointed with some medicinal 
agent. These may be placed by the physician 
daily, or two or three times weekly. It will be the 
nurse's duty to have these tampons in readiness. 
They may be made by cutting strips in the length 
of a lap of cotton or wool, from six to eight 
inches long, doubling these strips and tying a 
piece of twine about six inches in length to one 
extremity. 
Preparation Before the tampons are placed the vagina should 

for use of Jr Jr & 

tampon. ^ c c l eansec [ by an antiseptic injection, as bichloride 
of mercury 1-4000. As the medicinal applications 
used have frequently the effect of increasing the 
mucous discharge from the vagina, a napkin should 
be worn after these treatments. The cotton should 
be removed, at the time appointed by the physician, 



GENERAL NURSING IN PELVIC DISEASES. 1 87 

by drawing upon the string. It should be wrapped 
in a piece of paper and burned, or thrown down 
a privy vault — never in a water-closet, as it will 
cause stoppage of the waste pipes. The patient 
should then receive a thorough vaginal injection. 

Pessaries. — Should the patient have a pessary Pessaries, 
adjusted, that is a support for the displaced uterus, 
the nurse should not permit her to move about if it 
caused her pain, at least until the physician ac- 
quiesced in her doing so. Any unusual complaint of 
pain or increase of vaginal discharge from its pres- 
sure, should be reported to the physician. A pa- 
tient should understand fully that it is unsafe to 
wear such a support without the supervision of a 
physician, who shall advise her as to the necessity 
of having it removed from time to time for cleans- 
ing and replacement or entire removal. 

Counter-irritation over the low r er part of the Counter- 

■•■ irritation 

abdomen may occasionally be called for in the 
form of blisters, ointments, poultices, etc. In the 
management of these the nurse should follow the 
ordinary rules for their application elsewhere. 
Poultices of flaxseed, or hot-packs, should, if re- 
quired for warmth, be applied frequently enough 
to keep up warmth, about once in two hours. The 
latter consist of pieces of flannel or several layers of 
soft muslin wrung out of boiling water, to which a 
little glycerine may or may not be added. These 



irritation. 



i88 



DISEASES OF WOMEN. 



Blisters. 



Mental 
occupation. 



are applied as a poultice, being covered by a piece 
of oiled silk or muslin, and to still more effectually 
prevent evaporation, by a layer of cotton wool. 
An abdominal binder, held in place by a perineal 
bandage or an ordinary T-bandage, will serve to 
keep these applications in place. Ointments are 
best applied on patent lint or soft Canton flannel. 
They should be spread the thickness of a knife-blade. 
The best means of keeping such applications in 
place is by strips of rubber adhesive plaster. A 
piece of oiled silk or cotton batting should be 
applied over this to prevent the greasing of the 
clothing. 

A blister should be carefully watched and 
removed as soon as the scarf-skin fills up with 
liquid beneath it. If it seems slow in rising, as it 
should in five to six hours, a flaxseed poultice 
applied over it will hasten the process. In dress- 
ing the blister, care should be taken not to remove 
the scarf-skin, but clipping a small opening in the 
most dependent part of the blister, the liquid may 
be soaked up by absorbent cotton or soft rags, and 
the blistered surface dressed with cold cream, cos- 
moline, etc., applied on lint. The fluid from the 
blister should not be allowed to run over the skin 
elsewhere, as it will produce irritation. 

Mental Occupation. — The more entirely a nervpus 
patient's mind can be kept occupied with other 



GENERAL NURSING IN PELVIC DISEASES. 1 89 

things than herself, the more successfully may she 
be treated. Upon the nurse will devolve the duty 
of supplying wholesome for unwholesome thoughts. 
For this reason, if none other, a nurse should keep 
up as far as possible, a knowledge of the events of 
the day. She should be able to talk to her patient 
about the world and its doings, and thus help to 
widen her horizon and prevent the fret and worry 
which result from a persistent contemplation of 
small woes. All gossip should be carefully avoided. 
It is necessary that the nurse should be a good 
reader, and should train herself to read aloud, for 
she may in this way while away many a weary hour 
which might otherwise be spent in profitless 
thought. As additional recreation for younger 
patients particularly are some of the card games, 
or puzzles, etc., which are interesting because of 
the incentive they give to thought. 

With infinite tact a patient may be thus led, ^ t ueof 
without knowing it, into a more wholesome mental 
atmosphere than that which she has been accus- 
tomed to breathe. The effect upon her general 
health when this state of things can be obtained 
will be marvelous. The nurse will need to remem- 
ber that each patient offers her a new problem, and 
that she must not attempt the same methods with 
all. 



CHAPTER XVI. 

PREPARATIONS FOR GYNECOLOGICAL 
EXAMINATIONS. 

The nurse is frequently called upon to aid the 

physician in obtaining a satisfactory history of a 

disease. patient suspected of having pelvic trouble. The 

following plan is that generally adopted with us : — 

1. A short sketch of the family history, health of 
parents, brothers and sisters ; if any deaths among 
them, their cause. These facts are of importance 
as showing a predisposition to any especial class of 
diseases. 

2. The personal history of the patient, her health 
in childhood, the diseases from which she may then 
have suffered. Date of first menstruation, charac- 
ter as to existence of pain at periods ; amount 
of flow, regularity, etc. Date of marriage, number 
of pregnancies, number of miscarriages, number of 
labors, character of labors, character of convales- 
cence. General health during marriage or since 
puberty. 

3. History of the special disease from which the 

190 






examina- 
tion. 



PREPARATIONS FOR EXAMINATIONS. I9I 

patient may be suffering ; its onset, duration, char- 
acter of symptoms, supposed cause, etc. 

4. Present state of health, general appearance, 
character of functions, appetite, digestion, quantity 
of urine passed in 24 hours ; the urinalysis. Ex- 
amination of chest organs, abdominal organs and 
pelvic organs (determined by physician). 

5. Special examination with reference to tumor or 
existing disease. 

Physical Examination. — The physical examina- ph y si . cal 

s r J examina- 

tion of the pelvic organs is much better conducted 

upon a table covered with a blanket, rug, or com- 
fortable, and provided with a small pillow, than it 
can possibly be upon a bed or sofa. In this way 
one avoids the sinking of the body into the soft 
bed, and affords other facilities for a thorough in- 
vestigation of the diseased parts. A sheet or 
blanket for covering the patient gives the desired 
protection from exposure. 

When it is necessary to employ a bed a sewing- 
board, or the leaf of a dining-table slipped under the 
upper sheet and covering, gives a hard surface upon 
which the patient may lie. 

The patient's clothing should be loose around 
the waist, all the waistbands being unbuttoned or 
untied, corsets removed, and all heavy skirts. She 
should lie on her back in a first examination, unless 
directed otherwise by the physician. If the abdo- 



192 



DISEASES OF WOMEN. 



Adjustment 
of patient. 



Special 
tables and 
chairs. 



men is to be examined first, the patient's feet may- 
be placed on a chair or stand, as she lies on the 
table, the knees should be well drawn up so that 
the abdominal walls may be relaxed. A sheet 
should be spread over the lower limbs, the loosened 
skirts being either drawn down under it or thrown 
back over the chest, in order to expose the abdo- 
men. The sheet may be drawn up over the abdo- 
men, after the clothing has been adjusted for ex- 
amination, until the physician is ready to proceed 
to its inspection. The table should have been pre- 
viously adjusted in front of a window admitting a 
strong light. At 'the foot of the table should be 
placed a chair for the physician, and to its right a 
stand or chair with a basin of warm water contain- 
ing some antiseptic solution (bichloride of mercury 
1-4000), soap and a towel. 

When the pelvic examination is to be made the 
limbs must be drawn up and separated, the feet 
resting on a level with the patient's buttocks. The 
patient's skirts are pushed up beneath the sheet 
until they rest over the abdomen, the sheet covers 
completely the lower limbs, pelvis, and abdomen. 

A variety of gynaecological tables and chairs 
exist. The nurse will have to be taught the man- 
agement of any especial kind by the physician in 
whose office or hospital she may be called upon to 
work. In a private house an ordinary kitchen table 



PREPARATIONS FOR EXAMINATIONS. 193 

serves the purpose very well. The chief advantage 
of the special tables consists in the foot-rests, which 
are so adjusted as to let the patient's hips be brought 



Fig.' 51. 




Chadwick's Gynecological Table with Patient Arranged for 
Examination. 

well to the edge of the table, thus facilitating the 
use of the speculum. 

Should the patient be extremely nervous, or the 
investigation involve much pain, it may be neces- Useof 

i* >-»-' a.n36sthetic 

sary for an anaesthetic to be given. This can only 
13 



194 DISEASES OF WOMEN. 

be done with safety if the patient's stomach be 

empty. Therefore, it is well for the patient not to 

have taken any food for some hours before the ex- 

Preparation amination. The lower bowel should have been 

of bowels 

andbladder - thoroughly emptied by an enema prior to the ex- 
amination, and the patient should be required to 
void her urine. The condition of both these organs 
has much to do with success in an examination. 
It may be necessary, should there be difficulty in 
the voiding of urine, to use the catheter for the pa- 
tient prior to the examination. This should always 
be done immediately after etherization, when the 
patient requires to be anaesthetized, as the taking 
of ether, which usually causes considerable nervous 
excitement, is apt to lead to an excessive secretion. 
When an abdominal or pelvic tumor of any size 
exists, the soft rubber catheter, English or French, 
should be used. When the urethra is somewhat 
tortuous, the English catheter is preferable, because 
of its greater resistance. The silver or glass cath- 
eter might do injury to the tissues, because of its 
inability to adapt itself to the changes in direction 
of the canal. 

instruments The instruments to be used by the physician in 

for gYnseco- J *■ r 

logical ex- the course of the examination must be prepared 

animations. r r 

and handed to him by the nurse. 

These will be different forms of specula, as the 
bi-valve, the cylindrical and single blade specu- 



PREPARATIONS FOR EXAMINATIONS. 



195 



lum, the uterine dressing forceps, applicators, and, 
possibly, the uterine sound. 

There are many varieties of specula named for Specula. 



Fig. 52. 




The Uterine Sound. 



their respective inventors. Those most used are 
probably Cusco's bi-valve speculum, so called 



Fig. 53. 




Bi-valve Speculum. 



because of its having two blades. Fergusson's 
cylindrical speculum, made of clear glass, or glass 



I96 DISEASES OF WOMEN. 

silvered and covered with black varnish, so that it 
will act as a reflector. 

Fig. 54- 




Small Bi-valve Speculum. 

The cylindrical speculum may also be made of 
celluloid or hard rubber. 

Fig. 55. 




Fergusson's Speculum, Cylindrical. 

The single blade speculum, sometimes called the 
duck-bill speculum, or Sims' speculum, has also 
many modifications. 



PREPARATIONS FOR EXAMINATIONS. 



I 9 7 



It is not necessary to remember these by the 
names of their inventors, but rather to know them 
by their special characteristics. 

Metallic specula are nickel-plated, as a rule. ^^ 
Recently aluminium, which is a very light metal, made - 
has been used in making them. Aluminium specula 
have, further, the advantage of not tarnishing or 
corroding when they come in contact with the 

Fig. 56. 




Sims' Speculum (Duck-bill). 



chemical substances ordinarily used in making 
uterine applications. Bichloride of mercury will, 
however, corrode it, hence solutions of bichloride 
will need to be avoided in using this as other 
metallic instruments. 

Nickel-plated instruments should not be rubbed j^ieanfn 
too vigorously or too frequently with sandsoap, 
whiting, etc., as the nickel wears off. The boiling 



198 



DISEASES OF WOMEN. 



Dressing 
forceps. 



or steaming of such instruments is the better way 
of cleansing them after use. 

The dressing forceps and sound are usually of 
metal (steel, nickel-plated), although the flexible 
Applicators, sound may consist of rubber. Applicators, that is 
small rods for the carrying of cotton charged 
with some medicament to the neck or body of the 
uterus, may be of metal, rubber, or wood. A very 
convenient and inexpensive applicator for hospital 
use is the wooden splint about six inches long, which 



Fig. 57. 




Dressing Forceps. 



Preparation 
of instru- 
ments. 



represents one stage in the process of the prepara- 
tion of matches. These may be obtained in large 
quantities at match factories and kept with a little 
cotton twisted on one end for use as desired. 

The instruments as required for use by the 
examining physician should be taken from a warm 
carbolized solution in which they have previously 
been placed ; lubricated, if specula, with a little car- 
bolized cosmoline, in order that they may slip with- 
out resistance into the vagina, rectum or urethra, 



PREPARATIONS FOR EXAMINATIONS. I99 

and handed thus to the physician. After the Assistance 
speculum has been placed the nurse will need to amination 
hand the dressing forceps, between the extremities ment. 
of which a little dry absorbent cotton may be held. 
This will be needed to cleanse the passage of any 
discharge which may obscure the view. 

Similar pieces of cotton should be kept in readi- 
ness by the nurse, being placed as small twists or 
balls in a glass or china vessel within reach of the 
examiner, should more than the one be required. 

A waste bucket or bowl should be placed beneath 
the foot of the table to receive waste matter. 

Should the physician desire to make an applica- 
tion to the parts brought to view, the nurse may 
moisten the cotton on an applicator in a small 
quantity of the medicament specified by him, which 
should be poured out into a small china or glass 
vessel kept for the purpose. The cotton should 
not be saturated with the substance, as it may then 
drip over the tissues where not desired and produce 
unpleasant effects. 

Should a tampon need to be placed, this should 
similarly be prepared by the nurse, caught between 
the blades of the dressing-forceps and handed to 
the physician. 

Upon the removal of the speculum, and after 
having assisted the patient to alight from the table 



200 



DISEASES OF WOMEN. 



Cleansing 
of instru- 
ments. 



Arrange- 
ment of 
positions. 



and dress, the nurse should give her attention to a 
thorough cleansing of the instruments used, par- 
ticularly if they are to be immediately employed 
for another case. 

They should be placed in warm water and 
scrubbed with nailbrush and soap. Should there 
be a steam sterilizer in operation in the room, they 
may then be dropped into it, until needed for the 
next patient. Ten minutes will suffice for their 
sterilization when the steam is at its height. In 
lieu of this, boiling water may be poured over 
them, or they may be placed in a 5 per cent car- 
bolic solution until again needed. On taking in- 
struments from so strong a carbolic solution, they 
should be rinsed in clear warm water before they 
are lubricated and handed to the physician for use, 
as they will otherwise cause the patient pain from 
the cauterant effect of the carbolic acid. Some phy- 
sicians sterilize their instruments for office use by 
holding them in the flame of an alcohol lamp for a 
few minutes. Another duty of the nurse, in attend- 
ance upon a physician making examinations, will be 
to place the patient in the positions desired. These 
positions are known as follows : — 

The lithotomy position, is the ordinary recum- 
bent position, the limbs being markedly flexed upon 
the abdomen. This is more commonly called for 



PREPARATIONS FOR EXAMINATIONS. 



20 1 



in certain operative procedures than during ex- 
amination. The method of maintaining it by the 
legstraps will be described later. 

The Sims position, for bringing the uterine cervix Sims' 

position. 

within easy access, and for making rectal exami- 
nations. The patient lies on her left side, with her 
left arm drawn behind her, so as to let her rest on 

Fig. 58. 




Sims' Position. 



the left side of her chest. The right leg should be 
so flexed as to let the right knee lie just above the 
left. This position is necessary for the use of Sims' 
speculum. The patient's clothing being well drawn 
up under her hips and a sheet thrown over the 
lower extremities for their protection, the physician 



202 



DISEASES OF WOMEN. 



Genu- 

pectoral 
position. 



introduces Sims' speculum, which the nurse holds 
in place with one hand, while with the other she lifts 
the right buttock to aid in the exposure of the 
vulvar orifice and vagina. 

The knee-chest position is one which is frequently 
assumed for the replacement of the pelvic organs, 
or the appreciation of their mobility. 



Fig. 59. 




Genu-pectoral Position. 

This is obtained by having the patient place her- 
self upon her knees, and bend forward so that her 
chest may rest on a pillow placed upon the bed 
or table, her head resting beyond the pillow on one 
side or the other. The arms should be placed in 
an extended position at her side or may be clasped 
around the sides of the table, so that she may not 



PREPARATIONS FOR EXAMINATIONS. 203 

be tempted to rest upon her elbows. This brings 
the hips to a point considerably above the head, and 
enables the abdominal and pelvic organs to gravi- 
tate towards the diaphragm. The patient's clothing 
should be pushed back from under her knees and 
lifted above her hips, the sheet being draped over 
her for the protection of the parts thus uncovered. 
A separation of the buttocks by the hands will allow 
of the entrance of air into the vagina, which will 
serve to force the pelvic organs forward. 

In cases of displacement of the uterus the nurse 
may be called upon to assist the patient to take 
this position several times daily. 



CHAPTER XVII. 

PREPARATIONS FOR GYNAECOLOGICAL OPERATIONS, 

The divisions of this subject may be classified as 
follows : — 

i. Preparation of the room. 

2. Preparation of the sponges, instruments, etc. 

3. Preparation of the patient. 

4. Preparation of operator and assistants. 

5. Nurse's duty during operation and convales- 
cence. 

PREPARATION OF THE ROOM. 

Excepting for vaginal hysterectomy (removal of 
the uterus through the vagina), which is to be 
regarded as a major operation, it will not be neces- 
sary to remove carpets, furniture, etc., from a room 
which is clean and thoroughly well kept. It is 
well, however, in any operation to have special 
for floor. on provision made for the protection of the floor. 

Prior to the operation the room should be thor- 
oughly swept and dusted, and well aired. Super- 
fluous furniture and hangings, because they inter- 
fere with ventilation, it is always desirable to 

204 



PREPARATIONS FOR OPERATIONS. 205 

remove. All operations are better done on a table The table. 
than on the bed. Therefore one should be pre- 
pared by the nurse. As in operations on the pelvic 
organs the patient will have to lie with her hips 
close to the edge of the table, the knees being 
drawn up, one table, of the ordinary size of a 
kitchen table, will be sufficient, without the table 
placed transversely to this for the head, as in ab- 
dominal section. 

The table should be placed before a window, so Position of 
that there may be thoroughly good light. Some arrange- 

r «i i i , ., , « ments for 

protective, as a piece of oil-cloth or drugget, should operation. 
be spread under it. The arrangement of the dress- 
ings for the table should be the same as described 
for abdominal section — a blanket or comfortable 
spread over the table and tacked down round the 
edges. A piece of rubber should protect this 
covering, at least over the lower half of the table, 
when the operating pad is not used. A sheet 
should be spread over these and similarly fastened 
down at the sides. A blanket and sheet for cover- 
ing the patient, and a pillow protected with rubber 
cloth fastened around it, under the slip, should be 
arranged on the table. A chair should be placed 
at the foot of the table for the operator. The 
stand for his instruments should be placed to his 
right, within easy reach. On this stand should 
also be found a tray or vessel containing a steril- 



206 DISEASES OF WOMEN. 

ized solution for him to dip his instruments into 
while in use, or to use in cleansing his hands, from 
time to time, of blood. 

Two assistants usually stand one on each side of 
the table, to aid the operator by holding the 
patient's limbs in any desired position, also in aid- 
ing with instruments, ligatures, sponging, etc. The 
nurse with her table for cleansing the sponges 
should stand back of the assistant on the operator's 
left, handing him sponges and receiving them from 
him for recleansing. Her stand should contain 
one basin filled with cold sterilized water for wash- 
ing out the blood, and another basin with warm 
sterilized water for keeping them in until needed. 

A chair or stool should be placed at the side of 
the table to aid the patient in stepping up. The 
window should be screened from the outside gaze 
by a thin lace or muslin curtain, or a sheet of 
newspaper may be pinned across it. A waste 
bucket should stand under the table immediately 
in front of the operator. The operating pad may 
be placed at the lower edge of the table so that its 
flap rests over the waste bucket and thus conducts 
the water used in irrigation, etc., into it. 

When the operator works without a pad it is 
well to have a folded sheet so placed over the 
lower portion of the table as to extend from beneath 
the patient's hips over the lap of the operator. 



PREPARATIONS FOR OPERATIONS. 



207 



This serves to protect the operator's clothing, the 
floor at the foot of the table, etc., from soiling. 

The bed for the reception of the patient after The bed. 



Fig. 60. 




Operating Pad. 



operation should be arranged beforehand. It 
should be so placed that access may be had to it 
on three sides. It should not face the light. A 
firm mattress, as of hair, is the most desirable. 



208 



DISEASES OF WOMEN. 



Warming 
the bed. 



Antiseptic 
solutions. 



Care should be taken to see that the bed is in every 
way comfortable. A pad should protect the mat- 
tress, and a rubber protective should be so placed 
over this as to cover the portion of the bed, over 
which the parts operated upon shall rest. In pelvic 
operations this will be the middle of the bed, in a 
breast operation the upper part of the bed. A 
sheet is spread over these, and a draw-sheet, that is, 
a sheet folded upon itself twice in its length, is 
fastened over the portion of the bed beneath which 
the protective has been placed. 

A heated soapstone or hot-water bag should be 
placed, previous to the operation, between the 
upper and lower bedclothes, so that the bed may 
be warm for the reception of the patient. 

The nurse should learn before the operation the 
kind of solutions to be used, if antiseptic solutions 
are to be employed. Should bichloride of mer- 
cury and carbolic acid be employed, which are the 
usual solutions desired by surgeons, a large 
bottle containing a solution of 1-500 or 1-1000 of 
the former and another containing 1-20 of the lat- 
ter will enable the weaker solutions to be prepared 
with great rapidity. Thus, if a solution of 1-4000 
of the bichloride be called for, the nurse taking 
one part of the 1-1000 (as one gill) can add three 
parts (or three gills) of warm sterilized water to 
this, thus obtaining a warm solution of the required 



PREPARATIONS FOR OPERATIONS. 2O9 

proportion. If a bath thermometer be kept in the Regulating 

• 1 • 1 1 • 11 t * ie tempe- 

basin during the admixture of the solution and the ratureof 

. solutions. 

water, the nurse may, by watching the column of 
mercury, determine whether to make the addition 
from the warm or cold water, until she obtains the 
quantity desired. 

A solution of 1-1000 can be prepared by mixing ^f^jck 
in equal parts the solution 1-500 and warm sterilized ofsoiuTion S n . 
water. 

A solution of 1-40 carbolic acid (that usually 
employed for the immersion of instruments) may 
be made by adding the same quantity of warm 
sterilized water to a solution of 1-20. 

Sometimes surgeons prefer the use of tablets of 
bichloride in making up solutions. The directions 
as to the strength of one of these will be found 
upon the vial in each case. As a rule, a tablet 
represents 7^ grs., which, when added to a pint of 
water, gives a solution of 1-1000. A fountain 
syringe containing the solution to be used should 
be filled and hung behind and considerably above 
the operator, on a nail, that it may be ready when 
needed. 

When the operator is obliged to use the edge Arrange- 

ments when 

of a bed in place of a table, the bed should be operation 

1 done on 

placed with one side sufficiently near the window bed - 
to obtain a good light. The sinking of the patient 
in the bed may be prevented by placing a board 
14 



2IO DISEASES OF WOMEN. 

beneath the mattress and the springs, or between 
the mattress and pad. This portion of the bed 
should then be arranged for the operation in the 
same way that the table was arranged as to the 
protective rubber and sheet. 

A chair or stool of proper height with reference 
to the bed should be placed in front of this arrange- 
ment. The floor, for about one foot beneath the 
bed, on that side, and extending to at least two 
feet beyond it, should be protected by floor oil- 
cloth or old carpeting. 
Prepara- The stands and other articles required should be 

tion ot x 

sponges, arranged as before described. The preparation of 
sponges and instruments for the operation will be 
identical with those described in the chapter on the 
subject of their preparation for abdominal section. 
The dressings employed will vary somewhat as to 
their character, form, etc., with the choice of the 
operator. 

T-bandage For operations upon the floor of the pelvis, or 

and anti- . . r . r . . 

septic pad. within the vagina, a T-bandage with an antiseptic 
pad of some kind will be necessary. The T-band- 
age will consist of a straight abdominal bandage 
of firm muslin, to which a strip of muslin about 
four inches wide is fastened at right angles, so that 
it may serve as a perineal band passing between 
the limbs and fastened before and behind to the 
lower ed^e of the abdominal bandage. 



PREPARATIONS FOR OPERATIONS. 211 

A folded towel or napkin, pinned by a safety-pin 
to the abdominal bandage, serves the purpose very 
well. 

The antiseptic pad is usually made of one of the 
different kinds of antiseptic gauze, in which anti- 
septic jute, oakum, or cotton may be enclosed. 

In the Woman's Hospital the Garrigues' " Oc- Occlusion 

dressing. 

elusion Dressing," somewhat modified, similar to 
that used for obstetric work in the Maternity con- 
nected with the Hospital, has been employed. 

This consists of one or more pieces of dry patent 
lint, 6x8 inches, which have previously been ren- 
dered antiseptic by saturation in a solution of bichlo- 
ride of mercury i-iooo. 

These are placed over the vulva, doubled in their 
width so as to make a dressing 3x8 inches. The 
lint is then covered by a piece of gutta-percha 
tissue, 4x9 inches, which is wet in a 1-4000 solu- 
tion of bichloride of mercury. 

These dressings are kept in place by a napkin of 
sublimated cheese-cloth, 18 inches square, folded to 
form a diagonal 5 inches in width, within whose 
folds a pad of oakum is enclosed. The napkin is 
tightly fastened to an abdominal bandage, both 
anteriorly and posteriorly by means of safety pins 
and the access of air to the vagina is thus prevented. 
These dressings are changed as they may require, 
according to the amount of discharge. Should the 



212 DISEASES OF WOMEN. 

catheter have to be used at stated intervals, fresh 
dressings should be employed in again protecting 
the parts. 

The nurse can obtain the cheese-cloth at any 
drygoods store, and prepare it by first thoroughly 
washing with softsoap and boiling, and then wring- 
ing it out in a solution of bichloride of mercury 
i-iooo. The patent lint, obtained in a drug store, 
may be rendered antiseptic in the same way. 
The gutta-percha tissue and oakum may also be 
obtained at a drug store, the former more advan- 
tageously, perhaps, at a rubber store, where also a 
good syringe should be obtained for use in the 
case, if required. 

Although bichloride gauze is most commonly 
used, iodoform gauze may be preferred by some 
surgeons. 

The preparation of ligatures and sutures, the 
threading of needles, etc., does not usually devolve 
upon the nurse, yet may be required of her. The 
same rules must be observed as in their prepara- 
tion for abdominal operations. The needles vary 
much in size and shape, according to the character 
of the operation to be done. The surgeon, too, 
will have his own choice as to the kind of needle 
he prefers. The nurse must, therefore, learn his 
preference and observe it. 

A sterilized towel, containing a set of dressings 



PREPARATIONS FOR OPERATIONS. 213 

neatly folded, the bandage, safety-pins and box of 
iodoform powder to be used in the dressing of the 
wound, should be brought to the surgeon by the 
nurse at the proper time for their application, 
hence should be kept in readiness. 



CHAPTER XVIII. 



PREPARATION OF THE PATIENT, 
ASSISTANTS. 



OPERATOR, AND 



A good 
mental con- 
dition. 



Prepara- 
tion of 
bowels. 



Abstinence 
from food. 



Rest. 



First of all it is important to get the patient into 
a good mental condition. She should have her 
thoughts, so far as possible, kept off the operation. 
The utmost tact will be necessary to manage this 
successfully. 

It is well to make all the preparations for opera- 
tion elsewhere than in the presence of the patient. 

If the operation is to be on the pelvic organs, in- 
volving vagina, uterus, bladder, or rectum, it will be 
especially necessary to have a thorough evacuation 
of the bowels. The night before the operation a 
laxative or purgative may be given, and the morn- 
ing following ; the lower bowel may be further 
cleansed by an injection of soap and water. 

The patient should not have any breakfast on the 
morning of the operation. If the operation is not 
to be done before noon, she may receive a cup of 
coffee or tea, or a cup of beef-tea early in the morn- 
ing. 

She should remain in bed, lest she should feel 
faint for want of food. 

214 



PREPARATION OF PATIENT, ETC. 21 5 

A full bath should have been taken on the night Bath, 
previous to operation. She should wear, according 
to the weather, a merino or gauze vest, a pair of clothing. 
drawers and stockings, a long nightdress. When 
the vest is worn a chemise should be dispensed 
with, as it is an awkward garment to remove when 
a change is needed, especially where the patient 
must be kept as quiet as possible. The hair should m^nTIf" 
be parted in the back and plaited in two braids, one halr * 
behind each ear. This is most convenient when 
lying upon the back, and prevents matting of hair. 

A vaginal injection of bichloride of mercury or vaginal in- 
some other disinfectant will probably need to be 
given just before the operation. The vulva and cleansing 

& J . . # and disin- 

surrounding parts will need especial preparation by fectionof 
a thorough cleansing, first with soap and warm 
water and then with some disinfectant solutions. 
The hair about the vulva is often shaved up* to a pa r a t s ingof 
level with the " meatds urinarius," or entrance to 
the bladder. The choice of the surgeon regarding 
the shaving should be learned by the nurse pre- 
vious to her attempting the same. Many surgeons 
prefer attending to the especial preparation of the 
site of operation after etherization. 

In private houses the anaesthetic is generally Adminis- 

r & y trationof 

administered in an adjoining room, and the patient thean^s- 
afterward carried in and placed upon the operating 
table. The nurse aids the surgeon in carrying 



2l6 



DISEASES OF WOMEN. 



Arrange- 
ment of 
patient. 



out these arrangements. She should learn from 
him in what position the patient is desired when 
placed upon the table. The dorsal position — the 
patient lying upon her back with the limbs flexed — 
is that usually required for operations upon the 
vagina or the perineum. The patient's clothing in 



Fig. 6i. 




Leg-holder. 



this position should be well drawn up from under 
the hips and pushed above the operating pad, 
which is then placed under her. The limbs being 
Leg holder flexed may be fixed in position by the leg-holder, as 
shown in the cut, or held by assistants. The leg- 



PREPARATION OF PATIENT, ETC. 



217 



holder being thrown around the patient's neck is 
fastened, just above the knee, to each limb. 

A sheet should be so draped over the person as 
to cover the limbs and protect the patient so far as 
possible from unnecessary exposure. 

A double fold of sterilized gauze, about a yard 
square, with a slit cut in it, through which the 



Fig. 62. 



FIG. I 




Dorsal Position and Arrangement for Operations on Floor of Pelvis. 



special site of operation may be exposed, is used by 
some surgeons as a further protection against ex- 
posure, being draped from beneath the sheet over 
the vulva and buttocks, the operator carrying on 
his manipulations through the opening which 
exposes the special site to be operated upon. 



218 



DISEASES OF WOMEN. 



Sims' 
position. 



" Genu-pec- 
toral " posi- 
tion. 



Prepara- 
tion of 
operator 
and assist- 
ants. 



The Sims position is frequently used in cervical 
operations, for fistulse, or for operations about the 
anus, as for hemorrhoids. 

The knee-chest position is but seldom used for 
operation except in certain forms of fistulae. The 
patient's chest in such cases may need to be sup- 
ported by a thick pillow or a padded stool, to bring 
her into proper position for the operator. 

The nurse should in every case aim to keep the 
patient's clothing out of the way of the operator, 
and from contact with the discharges, but she 
should so adjust sheets, towels, etc., as to save the 
patient any unnecessary exposure. 

The preparation of the operator and assistants 
will be practically the same as that observed in 
preparation for abdominal section. 

Any open surface upon the patient's body may 
become a source of infection, therefore the require- 
ments of asepsis and antisepsis should be as rigidly 
observed as possible in the preparations for any 
operative procedure. 



CHAPTER XIX. 

DUTIES OF NURSE DURING OPERATION. 

The patient being placed, and the operation be- 
gun, the nurse, unless directed otherwise, will need Sponges. 
to station herself by the stand which contains the 
vessels for cleansing the sponges. Several " mounted « Mounted 
sponges" should be prepared, that is, sponges cut 
about the size of a walnut, placed on stems of metal 
or rubber, called sponge-holders. Forceps with 
catches may be used when these are not on hand. 

For operations in the vagina or on the cervix, 
etc., these mounted sponges are especially neces- 
sary. 

The nurse, while attending to the sponges, espe- Attention 

° * ' * to surgeon s 

daily, should be ready to respond to any demand needs * 
of the surgeon — changing the water in the basins, changing 

& . . & & . of solutions 

refilling the irrigator, removing soiled towels and in basins. 
replacing them with fresh. Her own hands should cleansing 

1 ° of her own 

be carefully cleansed after each of these services, in a hands - 
basin containing some antiseptic solution, as 1-4000 
bichloride of mercury, before she again touches 
the sponges. 

The sponges should be thoroughly cleansed of 
219 



220 



DISEASES OF WOMEN. 



Manage- 
ment of 
sponges. 



Avoidance 
of curiosity. 



Attention 
to duty. 



Duties at 
comple- 
tion of 
operation. 



Application 
of dress- 



ings. 



Removal of 
patient to 
bed. 



blood in the basin of cold water and allowed to lie 
in warm water until wanted. They should be 
squeezed until as free of moisture as possible, and 
should be handed in quick succession to the assist- 
ant nearest to her who will have the sponging to 
attend to. 

At no time in any operation should the nurse 
allow herself to become so engrossed in watching 
the operation as to forget that there are duties 
incumbent upon her. She should give her sole 
attention to the performance of her own duties, and 
no more think of watching the operation (except 
as she may need to do so for the proper apprecia- 
tion of the special duties that may devolve upon 
her at each step), than should the etherizer, whose 
sole attention should be engrossed in the proper 
performance of his work. 

At the completion of the operation, the nurse 
may assist in slipping the rubber pad from beneath 
the patient. It may be placed in the waste bucket 
temporarily, while she proceeds with a sponge and 
a dry sterilized towel to prepare the parts for the 
application of the dressings. When entirely dry 
the powder, boric acid, or iodoform may be applied 
by the surgeon, and then the dressings are put in 
place and fastened down by a bandage. A blanket 
is then wrapped around the patient and she may be 
lifted into the bed which the nurse, just before the 



DUTIES OF NURSE DURING OPERATION. 221 

application of the dressings, should have prepared 
for her reception, by turning down the covers and 
removing temporarily the hot soapstone or water- 
bag. The latter may then be replaced at the pa- Application 

b i of warmth. 

tient's feet; a soft towel should have been placed, in 
lieu of a pillow, under the patient's head and another 
towel should be placed under her chin. A light F ^ rth ^ r 

l o attentions. 

basin for the patient to vomit in, in case she is sick, 
should be placed under the head of the bed; a 
chair for the doctor should be placed beside the 
bed. While the doctor and his assistant give their 
attention to the patient, the nurse may quickly artSes 3- ° 
remove all the articles used during the operation, operation's^ 



CHAPTER XX. 

SPECIAL NURSING IN GYNAECOLOGICAL 
OPERATIONS. 



Points of 
difference 
in manage- 
ment of 
cases. 



Immediate 
attentions 
after 
operation. 



Cleaning of 
room. 



Exact 
directions. 



There will be little points of difference in the 
management of each case, which will depend upon 
the character of the operation performed. Some 
of the most frequent gynaecological operations will 
therefore be referred to separately, in order that 
the especial points in their nursing may be demon- 
strated. 

After minor operations there is seldom the pro- 
found shock which exists after an abdominal or 
any other major operation. Should there be, the 
nurse will need to give her attention to the restora- 
tion of the patient, as has already been described in 
the treatment after abdominal section. 

Should the nurse not be needed by the patient, 
the doctor or his assistants remaining for a short 
time with her, the nurse may quietly and quickly 
busy herself with removing the operating table, 
soiled sheets, towels, etc., and setting the room in 
order. When the doctor leaves, her place is by 
her patient. 

Careful directions should be received by her as 

222 



SPECIAL GYNECOLOGICAL NURSING. 223 

to her especial duties in each case. She should 
inquire of the surgeon whether the patient may be 
permitted to have her position changed from time 
to time ; what shall be done concerning the use of 
the catheter; the amount of nourishment given the 
patient; the use of any medicines, etc. These facts 
should be carefully put down on paper and kept 
for her guidance in the care of the case. 

Rupture of the perineum is so frequent that the r h e aphy°for 
operation for its repair, known as the " perineal perineum. 
operation," is the most common of the gynaeco- 
logical operations. The extent of the laceration 
which is usually the result of childbirth varies. 
When it extends through the sphincter muscle of 
the bowel it is called a complete rupture. ri°p7ure. te 

It is not only important in the repair of these 
injuries that the operation should be well done, but 
that the healing of the wound should in every way 
be promoted. The patient's general health should, to^SSit- 
therefore, be in a satisfactory condition, and the operation. 
bowels should have received very careful attention 
for several days. When we remember that the 
intestinal canal is about twenty-five feet long, and 
that faecal masses are often kept stored up in it for 
months, we can understand how free evacuations 
on several successive days may be necessary before The 
the patient is in fit condition for operation. Some bowels - 
laxative, as recommended by the physician in 



224 



DISEASES OF WOMEN. 



Hemor- 
rhoids. 



Vaginal 
discharges. 



Position 

during 

operation. 



Special ar- 
rangements 
for opera- 
tion. 



charge of the case, will be necessary during this 
period. The opening of the bowels twice every 
twenty-four hours is not too frequent. An enema 
will need to be administered a few hours before 
operation. Care should be taken not to set up a 
diarrhoea, as this condition may cause greater 
inconvenience than constipation during the con- 
valescence. The preparatory treatment will also 
include attention to hemorrhoids, if they exist, or 
discharges from the uterus and vagina. When 
hemorrhoids exist, it is well to keep them sup- 
ported by a T-bandage, and a compress over the 
anus. 

Discharges from the vagina, which may interfere 
with healing, must be cured before the operation is 
undertaken. The use of hot-water injections, given 
by the nurse, and local treatment as required by 
the physician, will be necessary for this. 

For the operation the patient will need to be 
placed in the lithotomy or dorsal position. The 
preparations for fixing her in this position should, 
of course, not be undertaken until she is fully 
etherized and no longer in a condition to be fright- 
ened by them. 

Her limbs may then be flexed upon the abdomen 
and held either by an assistant on each side, or by 



the 



legholder. 



The clothing: under her back 



being well pushed up, the hips are brought to the 



SPECIAL GYNAECOLOGICAL NURSING. 225 

edge of the table and the operating pad adjusted 
beneath them. The parts are washed thoroughly, 
first with soap and water and then an antiseptic 
solution, and the hair on the posterior part of the 
vulva and the perineum shaved away or cut close. 
Sterilized sheets or towels are made to envelope 
the limbs and protect the parts. A large pan or 
foot-tub should lie just below the parts on the 
floor, so as to catch blood or water used in irriga- 
tion. The labia are held apart by the assistants on 
each side. The fingers of one hand of each of the 
assistants can hold back these greater lips, while 
the other hand of each remains free to assist with 
sponges, holding instruments, etc. The assistants 
should stand so as to keep out of the operator's 
light. The nurse attends to cleansing and handing 
the sponges, changing the water in the basins, and 
responding to the needs of surgeon and assist- 
ants. After the completion of the operation a 
T-bandage with antiseptic dressings, as before f P d P ress- l ° n 
described, may be applied or not, according to the mgs " 
wish of the surgeon, and the patient placed in bed. 
The knees and thighs are flexed, and she is put After-care. 
to bed on the right or left side, as a rule, although 
many surgeons now put little stress upon position 
as important in the after-management of their cases. 
Some surgeons prefer that the patient should con- 
tinue to lie on her side, her position being made 
i5 



226 



DISEASES OF WOMEN. 



Catheteri- 
zation. 



comfortable by pillows, until a day or two after 
removal of sutures. 

The external parts will, from time to time, require 
washing, as a rule, as there is sometimes a little 
discharge. The washing may be accomplished by 
means of a stream of tepid antiseptic solution, as 
bichloride of mercury 1-4000, or 1-40 of carbolic 
acid, from a syringe, and the parts then carefully 
dried with a piece of antiseptic lint or gauze. If 
there is no discharge, the parts should simply be 
kept dry. A powder, as boric acid or iodoform, 
may be dusted over the site of the wound from time 
to time, to insure this. The vagina will only need to 
be washed out, should there be a discharge. Great 
care must be taken in the insertion of the nozzle 
that no injury is done to the stitches. It should 
be seen that the water returns freely from the 
vagina. Pressing the nozzle of the syringe against 
the anterior wall of the vagina will be apt to leave 
space enough for the return current. 

The catheter may need to be used every six or 
eight hours for several days. A loaded bladder 
makes the patient restless. Some surgeons prefer 
having the patient pass her water from the first. 
There is probably little, if any, danger of urine irri- 
tating the wound. Should the urine be passed, the 
parts should be afterward irrigated with an anti- 
septic solution and thoroughly and carefully dried. 



SPECIAL GYNECOLOGICAL NURSING. 227 

The use of the catheter, unless aseptically carried 
out, may cause irritation of the bladder, which is 
often a source of great suffering. 

The question of opening the bowels is very im- Time and 
portant, especially in cases of complete rupture, securing an 
The practice of surgeons differs in this respect. the bowels - 
Some keep the bowels locked for a week or ten 
days, by the administration of opiates. The usual 
practice, however, is to keep the bowels free from 
the first, as the hard masses (scybala) which are apt 
to form put the united parts to great danger, from 
the strain to which they subject them. 

If the bowels have not been moved by the fourth 
day, the practice is to administer a gill of cotton- 
seed oil by bowel, allowing it to remain while 
laxatives are administered by mouth, as a tea- 
spoonful of castor-oil every hour, until four to six 
doses have been taken, or the bowels feel like 
moving. The dose of oil may be administered in 
a half a Seidlitz powder, flavored with a drop of oil 
of peppermint, or gaultheria, or a little syrup of gin- 
ger, etc. This prevents the nausea attendant usually 
upon taking the oil. By this method, a soft evacua- 
tion of the bowels is secured, and, if the precaution 
be taken to have the patient lie on her side while 
the bowels are moved, there will be little injurious 
effect from strain. A thorough irrigation and cleans- Subsequent 

° ° cleansing. 

ing and drying of the parts should follow. Should 



228 



DISEASES OF WOMEN. 



Diet 



Relief from the patient be disturbed by flatus before the bowels 
are moved, having a bearing down sensation with 
pain, an English catheter, about No. 9 or 10, may 
be insinuated into the bowel and thus aid the 
escape of gas. 

The diet of the patient for 24 to 48 hours should 
be simply milk, broth, or beef-tea, and this with 
farinaceous foods should be given until about the 
fifth or sixth day, when meat should be given. 

The deep perineal sutures, or stitches, should be 
removed in about eight or ten days. The rectal 
sutures do not always require removal. The nurse 
will need to place the patient across the bed for the 
purpose, drawing her hips close to its edge, and 
flexing the limbs. Her limbs should be protected 
by slipping on a pair of drawers and stockings. A 
sheet should in addition be thrown over her and 
draped around the limbs. A sheet or napkin should 
be placed under her hips. 

A chair for the surgeon should be placed in front 
of the patient, and a sheet or towel thrown over his 
knees as he takes his seat. 

As the surgeon usually desires to give a vaginal 
injection before removing the stitches, if he has not 
directed the nurse to attend to giving this injection 
herself, she should have in readiness the antiseptic 
solution required, a syringe, and a bedpan. The 
instruments, straight, sharp-pointed scissors and a 



SPECIAL GYNAECOLOGICAL NURSING. 



229 



pair of anatomical forceps, should be placed in a 
tin basin and immersed in a carbolic solution 1-40. 
An antiseptic solution, as 1-4000 of bichloride of 
mercury, should be prepared in a china or agate 
basin for the doctor's hands. 

A pus-pan or piece of paper for receiving the 
stitches as removed should be placed on the bed, 
within convenient reach of the surgeon. The nurse 

Fig. 63. 




Aseptic Anatomical Forceps. 
The two branches being separable are more readily cleansed. 



should then support the patient's limbs, or, if there Removal of 

1 x L sutures. 

are other assistants to do this, she will assist the sur- 
geon in giving the douche, and in obtaining for him 
or handing him the various articles required as he 
needs them. After the removal of the stitches she 
assists in putting the patient properly back in bed 
and removes the articles which were used in the 
operation. 



230 



DISEASES OF WOMEN. 



Necessity 
for quiet 
after 
sutures 
removed. 



Operation 
for partial 
rupture of 
perineum. 



Elytror- 
rhaphy or 
Polpor- 
rhaphy. 



After-treat- 
ment. 



Removal of 
sutures. 



The patient will need to be kept quiet, as a rule, 
for a day or two after the removal of the stitches. 
The nurse should, however, always learn from the 
surgeon his special wishes concerning the subse- 
quent management of a case. 

In partial rupture of the perineum the manage- 
ment is practically the sameas in complete rup- 
ture, except that there will be less fear of damage 
when the bowels are opened on the third or fourth 
day, and that the stitches are usually removed at 
the end of a week. 

The operation for repair of the perineum is known 
as perineorraphy. The various methods of doing 
this operation are known by the names of their 
different inventors. 

Elytrorrhaphy or colporrhaphy are commonly 
known as " vaginal operations," that is, operations 
on the vagina for the relief of prolapsus, or falling 
of the womb. 

The after-treatment is much the same as in cases 
where rupture of the perineum has been repaired. 
The patient will need to lie in bed for over two 
weeks, and the bladder must never be allowed to 
become distended, or the cicatrix will be stretched 
or broken down. The sutures are removed from 
the tenth to the fifteenth day. The patient will 
need to avoid active exercise for many months. 

Trachelorrhaphy is an operation done for the re- 



SPECIAL GYNECOLOGICAL NURSING. 23 I 

pair of the cervix or neck of the womb, when Tracheior-i 
laceration exists. It is frequently spoken of as a cervical 

. operation. 

" cervical operation." Before this operation is per- 
formed, the surgeon generally has the patient put 
upon preparatory treatment for a week or two, to ^ r r ep ^ r r e a a * t 
remove all tenderness and congestion. Hot water ment - 
injections daily, sometimes several times a day, are 
ordered, after which the doctor may apply tam- 
pons of glycerine, etc. 

Some surgeon's prefer the semi-prone or Sims' Jhe opera- 
position for this operation, as this enables the neck 
of the womb to be brought within easy reach. The 
operation is more frequently performed with the 
patient on her back, in what is called the dorsal 
or lithotomy position. 

The patient should remain in bed a fortnight or Rest in 
more after the operation and remain in the recum- 
bent position so that there may be no strain upon 
the stitches. Some counter-irritant, as burning 
fluid, is frequently applied on cotton over the lower 
part of the abdomen. The bowels should not be T he 

x bowels. 

allowed to get constipated, a movement being se- 
cured by means of laxatives daily or every other 
day. 

The patient's diet need not be restricted. After Diet, 
the second day, especially if there be much dis- 
charge, a vaginal injection of tepid water, contain- vaginal 

injections. 

ing some antiseptic (as bichloride of mercury 



232 



DISEASES OF WOMEN. 



1-4000), may be employed. After urine has been 
passed or the catheter used, it is also well to use a 
warm-water injection to avoid irritation of the 
wound through urine which may pass into the 



Removal of 
sutures. 



The sutures are sometimes removed as early as 
the seventh day. The patient is placed in Sims' 
position for this, and the nurse will have to hold 
the speculum and support the right buttock, the 
patient lying on her left side, and vice versa when 
she lies on her right side, while the surgeon re- 
moves the stitches. More frequently the sutures 
are not removed until the fourteenth day, or even 
After-care, later, The patient should be kept quiet for some 
days after the removal of the stitches, not even 
sitting up in bed. This is to give time for the 
cicatrix to grow stronger. The nurse will, of 
course, observe the wishes of the surgeon in this 
as in other matters pertaining to the nursing. 

Operations for fistulae are not infrequent. A fis- 
tula is an unnatural opening produced by sloughing 
of the tissues. It may be the result of cancer, but 
in operable cases is more frequently the result of 
child-birth. The constant pressure of a pessary 
worn too long may cause it. An opening may in 
this way be formed between the bladder and the 
vagina, in which case it is called a vesico-vaginal 
fistula, or it may be formed between the bowel 



Operations 
for fistulse. 



Varieties of 
fistulse. 



SPECIAL GYNECOLOGICAL NURSING. 233 

and the vagina, when it is called a recto-vaginal 
fistula. 

Constant dribbling of the urine is occasioned by Symptoms. 
the former condition, while escape of faeces through 
the vagina is a result of the latter. 

The lithotomy position is that usually employed Method of 

. conducting 

in doing the operation, or examining for the condi- examina- 
tion. A Sims speculum retracts the perineum. 
When it is difficult to detect the fistula, warm milk 
may be injected into the bladder or rectum, and the 
vagina watched to discover where it makes its exit. 
This will betray the position of the fistula. 

Should a fistula occur as the result of a difficult Spontan- 
eous heal- 

delivery, it is possible that, if at once discovered in s- 
and properly treated, it may heal without an opera- 
tion. The vagina should be kept perfectly clean ^nsTobe 
by frequent syringing with warm antiseptic solu- observed - 
tions, and a self-retaining catheter should be 
placed in the bladder and the latter thus kept 
empty. 

In performing the operation for vesico-vaginal operation 

for vesico- 

fistula the surgeon will have the patient placed in vaginal 
the position he may prefer — the lithotomy, the 
semi-prone, or the genu-pectoral. The lithotomy 
position is usually employed. The bowels should t ^ n j; ara ~ 
be thoroughly cleared out by a laxative adminis- 
tered about forty-eight hours before the operation, 
and an enema an hour or two before the operation 



234 



DISEASES OF WOMEN. 



The patient's limb may be held by the leg-holder, 
the hips being placed over the operating pad. 
When all the stitches have been tied, the vagina 
and the bladder may be washed out with warm 
water (sterilized). If water is found to escape from 
the bladder into the vagina from the site of the 
wound, the operator will need to insert more 
After-care, stitches. After the operation a self-retaining 
catheter must be placed in the bladder to keep the 
urine drawn off. Some operators do not employ 
this. The catheter usually employed is the short 



Fig. 64. 




S- shaped Catheter. 



The self- 
retaining 
catheter. 



catheter with a bulbous extremity to prevent its 
slipping out of the bladder. The sigmoid or 
S-shaped catheter requires more frequent removal 
for cleansing, and is more apt to do injury upon its 
withdrawal and introduction, which must be done 
daily for cleansing it. The upper curve of the S is 
intended to hold the catheter in place by resting 
against the pubic bone. The bulbous catheter 
may be made of hard rubber or vulcanite, and will 
need occasional removal for cleansing purposes. 



SPECIAL GYNAECOLOGICAL NURSING. 235 

It is best washed in a strong solution of acetic 
acid. 

After the operation the patient is placed in bed, Position in 
on her left side. When a catheter has been intro- 
duced as described, a coach-urinal or a bedpan 
should be placed in the bed, behind the bent knees, 
which should be fastened together by means of a 
bandage. A piece of flexible rubber tubing is mSftfor" 
fitted on to the catheter at one end, the other U rinT. ng ° 
being passed into the urinal. When the patient is 
permitted to lie upon her back, the receptacle for 




Bulbous Catheter. 



the urine will need to be placed beneath her limbs. 
It is more liable to be pushed out of place in this 
position. The nurse must frequently empty and 
cleanse the receptacle, to keep the bed free from 
odor. The bowels must be kept in good condition, The 
no hard masses being allowed to collect in them, 
so as to cause irritation. No straining effort should 
be permitted. The faecal masses, if they exist, 
may be softened by the injection of a gill of warm 
cotton-seed oil, in three or four hours a pint and a 
half of soap and water may be injected. Should 



236 DISEASES OF WOMEN. 

several hours elapse and the enema be retained, 
it is a good plan to introduce a tube (as the long 
vaginal nozzle) to the extent of about four inches, 
letting the outer end rest over a soap dish con- 
taining a little water. The tube, if left thus ten 
or twenty, minutes, will usually carry off a quantity 
of flatus, and then the patient will, as a rule, have 
a free motion. Should the first enema prove 
unavailing, the process may be repeated. 

Before the stitches are removed, a free evacuation 
of the bowels should be obtained, and the vagina 

Removal of , . , . . , ,_. 

sutures. cleansed with an antiseptic solution. The sutures 
are removed about the eighth or tenth day. The 
patient is placed in the semi-prone position and 
Sims' speculum used. For this process, the patient 
is best placed on a table, as a good light is required. 
Some of the complications which may occur after 
this operation are as follows : — 

Hemor- Hemorrhage into the bladder — perhaps the most 

thebLdder. common accident — is shown by the color of the 
urine drained off, and, if managed in the beginning 
by injections of warm water, can thus be usually 
checked. If irritation of the bladder, however, 
persists, and it is found that the bladder is dis- 
tended, yet nothing can be drawn off by the cathe- 
ter, the distention must be due to clots, and the 

deration 7 sur g e on may have to reopen the fistula and remove 
the clots. Sometimes severe pain occurs extending 



SPECIAL GYNECOLOGICAL NURSING. 237 

from the kidney on one side down to the blad- closure of 
der. This symptom should be carefully reported, 
as it may imply that a ureter has been closed, and 
the removal of some stitches may be necessary. 

Cystitis, or inflammation of the bladder, is often Cystitis. 
a serious complication, as it leads to pain and a 
constant desire to empty the bladder, hence strain- 
ing efforts which may prevent the healing of the 
fistula. The bladder may need to be washed out Manage- 
frequently with warm water, containing boric acid ment ' 
or chlorate of potash, and the self-retaining cathe- 
ter cannot be worn. The surgeon will attend to 
the process of washing out the bladder, and the 
nurse should not attempt it unless directed by him. 
Warm poultices over the lower part of the abdo- 
men, and flaxseed tea or other diluents may 
need to be administered. Thus a tumblerful of 
flaxseed tea may be administered once in three or 
four hours. 

In recto-vaginal fistula the operation is conducted fo^cto- 11 
on the same principle as when a vesico-vaginal fis- ^f^ 1 
tula is treated. The bowels must be thoroughly 
cleaned out by an aperient administered twenty- 
four hours before operation, followed by an enema 
an hour or two before the patient is placed upon the 
table. 

A rectal tube or large-sized English catheter will 
need to be retained in the bowel after operation, to 



2 3 8 



DISEASES OF WOMEN. 



Removal of 

urethral 

caruncle. 



carry off flatus. The rules for after-treatment will 
be the same as in repair of complete rupture of the 
perineum. The chief trouble will consist in de- 
ciding as to the time when the bowels may be 
moved with safety. Efforts should be made to 
secure a soft movement, by means of the oil enema, 
as already described. 

The removal of urethral caruncle is another op- 
eration very frequently performed. The caruncle 
is a small, sensitive tumor, sometimes of quite a 
bright red color, which is found at the entrance to 
the urethra. It causes pain and difficulty on uri- 
nation, hence should be removed. When such 
growths cause no unpleasant symptoms, as is 
occasionally the case, it is not necessary to disturb 
them. 

The patient for this operation should be placed 
in the lithotomy position, and the urine drawn off 
after she has been etherized. 

The Paquelin thermo-cautery is frequently used 
Paqueiin's to sear the bleeding surface left by the removal of 
the tumor. The nurse may be called upon to pre- 
pare the cautery and have it in readiness. The 
finest point being fitted to the handle, it should be 
allowed to rest over the flame of an alcohol lamp 
until well heated. The rubber bulb at the end of 
the tube may then be compressed repeatedly and 
rather rapidly by the nurse until the point of the 



The opera- 
tion. 



Manage- 
ment of 



SPECIAL GYNECOLOGICAL NURSING. 239 

cautery becomes red hot. The vial containing 
benzine should be kept at a safe distance from the 
lamp and from the red-hot point, as the fluid is 
inflammable. The vial is usually provided with a 

Fig. 66. 




Thermo- Cautery (Paquelin's). 

hook, by which it may be fastened to a button-hole 
in the waist of the nurse's dress. One hand is then 
free for compression of the bulb and the other 
holds the cautery by its wooden handle. When 
the point of the cautery is red hot it may be re- 



240 



DISEASES OF WOMEN. 



After-treat- 
ment. 



Operations 
for hemor- 
rhoids. 



moved from the flame of the lamp and the heat 
kept up by compression of the bulb, which forces 
the vapor of the benzine into contact with the 
lower portion of the cautery. When the point 
seems to be getting cold rapid compression of the 
bulb will again heat it up. 

After the surgeon has finished with the use of 
the cautery it should be heated to a white heat by 
rapid compression of the bulb and the tubing 
pulled off the handle while it is still hot. This 
sudden cooling helps to preserve the point. The 
same instrument will sometimes be needed in the 
treatment of hemorrhoids — also for cauterizing the 
stump in abdominal section. 

The after-treatment in a case of urethral carun- 
cle is very simple. The patient should be kept 
quiet in bed for a few days, and the urine should 
be drawn off about once in six hours for the first 
day, after which the patient may pass it. It may 
not be necessary to use the catheter at all, should 
the patient be able to pass her water from the first. 

The use of some diluent drink will also aid in 
making the passage of urine less painful. 

After the removal of hemorrhoids or piles the 
patient often suffers considerably from swelling and 
throbbing pain. If but a portion of them have 
been removed the others may be temporarily much 
distended. Lint kept saturated with lead-water 



SPECIAL GYNAECOLOGICAL NURSING. 24 1 

and laudanum, or some other soothing application, 

will frequently give great relief, as will the use of 

astringent and anodyne ointments prescribed by 

the surgeon. A T-bandage and antiseptic pad will Dressings. 

need to be worn by the patient, and these will serve 

to hold the applications in place. 

For the relief of hemorrhoids preparatory to Palliative 

11 J treatment 

operation the application of cloths, wrung out in ^ r oids mor " 
hot water, will serve to shrink them, and then, 
being anointed with vaseline or some simple oint- 
ment, they should be returned into the bowel. 

Care to secure movements which are soft in con- Aftercare - 
sistency will be one of the chief objects in a nurse's 
attentions. The measures already described in the 
use of oil enemata, combined with a laxative, are 
most effectual. The patient's diet need not be 
restricted. She may need to be confined to bed 
from ten days to two weeks, according to the 
severity of the case. 

Lithotrity and lithotomy are operations for re- ^tone" 5 
moval of stone from the bladder which are occa- bladder. 
sionally done through the urethra and vagina. 
The preparations for these, as for other pelvic 
operations, consist in free purgation and rest in 
bed for a day or two. After the operation all 
efforts will be needed to allay irritation. 

The patient must remain in bed and mild drinks After-man- 

1 t agement. 

will probably need to be frequently administered, 
16 



242 



DISEASES OF WOMEN. 



Symptoms 
to be 
reported. 



Operation 
for pelvic 
abscess. 



Manage- 
ment of 
aspirators. 



as flaxseed-tea, barley water, soda water, milk, etc. 
The bedpan and urinal after lithotrity (crushing of 
the stone) should be used, and all fragments of 
stone kept for the doctor's inspection. 

In lithotomy special provision will have to be 
made by means of pads for the protection of the 
bed from the dribbling of urine. Sometimes a tube 
is left in the wound for a few days, and the nurse 
will need to learn from the surgeon what he desires 
done to keep it free from obstruction. The nurse 
must make every effort to keep the patient quiet, 
clean, and dry. The hips and buttocks must be 
washed frequently and oiled, to prevent irritation 
from the constant escape of urine through the 
wound. 

Any appearance of blood in the urine must be 
reported to the surgeon, also any disposition to 
chilliness, profuse perspiration, tenderness about 
the lower part of the abdomen, etc. 

Both these operations are done with the patient 
lying upon her back. 

The occurrence of abscess of the pelvis, which 
may point either externally or internally, sometimes 
demands the use of an apparatus known as the 
aspirator, which draws off the contents of the 
abscess by suction. A vacuum is produced in the 
bottle, as shown in the cut, by exhausting the air 
by means of the barrel* and, piston^syringe. The 



SPECIAL GYNECOLOGICAL NURSING. 



243 



return of air to the bottle being prevented by turn- 
ing the small button on the side next the syringe 
to close off communication there, and the valve on 
the opposite side being opened by adjusting the 
button on the needle-side properly, a suction power 
set up which draws out the contents of the 



is 



Fig. 67. 




Aspirator and Needles. 



abscess. A very thorough cleansing of the appara- 
tus is necessary after such use. 

The management of the case afterward will be After-care. 
directed by the surgeon and will depend on the 
location of the opening if one is made. If in the 
vagina, antiseptic douches will be required. If an 
external opening, a daily washing out of the 



244 



DISEASES OF WOMEN. 



Dilatation 
and curet- 
ting of * 
uterus. 



abscess cavity and re-dressing of the wound may 
be necessary. 

Operations for dilatation and curetting of the 
uterus, or removal of polypi or retained placenta, 
will need a similar preparation to that required for 
all pelvic operations. Especial care must be given 
to the employment of an antiseptic vaginal injec- 



FlG. < 




Intra-Uterine Return-Catheter. 



Use of 
intra-uter- 
ine syringe. 



tionjust before operation. The patient will need 
to be placed in the lithotomy position. During 
the operation the uterus will probably need to be 
washed out. For this purpose the intra-uterine 
syringe, one form of which is shown in the cut, 
may be employed. The lower figure shows the 
instrument as it is put together for use, the upper 
shows its separation into its three constituent parts. 






SPECIAL GYNAECOLOGICAL NURSING. 245 

It may be thus more thoroughly cleansed and 
rendered a safer instrument for use in different 
cases. 

One end of a piece of flexible rubber tubing is 
slipped over the outer end of the catheter, and the 
other end over the nozzle connected with a foun- 
tain syringe. The solution used is contained in 
the rubber bag of the syringe, and, flowing down 
through the tubing and into one channel of the 
intra-uterine syringe, is carried into the uterus, 
being carried back through the other channel. 
Care must be taken in using these instruments to 
see that the return flow is free. If not, it may be 
possible that the instrument is clogged by a clot of 
blood or some shreds of tissue. It must then be 
removed and cleaned and reinserted. A thorough 
boiling or steaming of the instrument, after taking 
it apart, should follow its use. 

Vaginal hysterectomy is an operation for the re- ^l^rec 
moval of the uterus through the vagina, and is tom y- 
most frequently done for cancer. 

The patient is prepared as for perineal operation 
and placed in the lithotomy position upon the 
table, the limbs being held by the leg-holder. 
The after-management of the case will be depend- 
ent upon the methods preferred by the surgeon. 
If forceps are used to clamp the vessels, instead of 
ligatures being applied, they will extrude from the 



246 



DISEASES OF WOMEN. 



vagina, and the nurse will need to be careful in 
watching them to see that they do not loosen and 
drop off, and that there is no strain on them in the 
slight changes of position to which the patient may 
need to be subjected. In fact, the patient should 
be kept very quietly upon her back and all move- 
ments avoided until after the removal of the clamps, 
in two to three days. Quiet should be maintained 
after the removal of the clamps, to avoid the dan- 
ger of secondary hemorrhage, until the surgeon 
declares all danger past. Antiseptic pads should 
be kept beneath the patient and frequently 
changed. 

When ligatures are used a thick pad of iodoform- 
wool or gauze is laid over the vulva, after the tam- 
poning of the vagina, and if a drainage-tube has 
been inserted in the vagina a sponge may be 
placed over its mouth. These dressings will be 
frequently inspected by the surgeon and changed 
if necessary. When the drainage-tube is used the 
pelvic cavity may have to be washed out should the 
temperature rise high or the discharge become 
offensive. Extreme care as to thorough asepsis 
will need to be practiced. The ligatures as a rule 
come away of themselves. If not, the surgeon 
may remove any sutures he may have introduced, 
and the remaining ligatures, at the end of two 
weeks. The patient will have to be placed on a 



SPECIAL GYNECOLOGICAL NURSING. 247 

table in the lithotomy position for this, and a Sims 
speculum used to depress the perineum. 

As very especial danger of hemorrhage exists 
after this operation, extreme watchfulness will need 
to be exercised by the nurse in the care of a case 
of vaginal hysterectomy, and a frequent inspection 
should be made of the dressings to discover the 
amount and character of the discharge. 

Operations on the breast may be done for the ^^^ he 
removal of tumors or cancer. The arm-pit must breast - 
be shaved and the breast made thoroughly clean 
by soap and water, followed by ether or turpentine 
for removing the grease from the skin, and then 
a thorough cleansing with bi-chloride solution, 
1-1000. The breast is then carefully enveloped in 
antiseptic dressings until the time for operation. The 
patient is prepared as for other operations. When it 
is near the time for operation the clothing may be 
removed from the side to be operated upon, but 
not from the other. A thin sheet of rubber gossa- 
mer or, in a private house where this cannot be 
had, a folded sheet should go under the breast 
and arm of the affected side, being turned in over 
the clothing and fastened upon the opposite 
shoulder towards the front by a shield-pin. 

The dressings should not be removed from the 
breast until the operator is ready to begin. If 
there is any delay a shawl or blanket can be thrown 



248 



DISEASES OF WOMEN. 



Other pre- 
parations. 



The dress- tietlt's clothing 

ings and 
bandages 



After-care. 



Watching 
for hemor- 
rhages. 



over the patient's shoulders until the surgeon is 
ready. 

The table for operation should be arranged as in 
any other operation, except that the operating pad 
should be placed at the upper part of the table, 
under the affected shoulder. Sterilized towels may 
be placed over the rubber-cloth protecting the pa- 
Special dressings will need to be 
prepared for the case ; thus, a large antiseptic pad 
which shall reach front and back to the median line 
of the body may be applied over the side of the 
chest whence the breast was removed, and this 
held in place by roller bandages firmly applied ; 
or, a straight bandage may hold the antiseptic 
dressings in place, and a second one be used to 
hold the arm firmly pinned down to the side. 
These bandages may be prevented from slipping by 
a strip of roller bandage fastened front and back 
to their upper edge and passing over the shoulder. 

The patient should be kept perfectly quiet after 
the operation. A little pillow 8 x 10 inches, of 
down or feathers, may be slipped under the arm of 
the affected side to support it and keep it from 
dragging down. The nurse must watch especially 
for any tendency to hemorrhage. As the blood 
will naturally run under the patient's back, owing 
to her position, she must be gently lifted or rolled 
towards the opposite side from time to time and the 






SPECIAL GYNAECOLOGICAL NURSING. 249 

back examined. Liquid food should be used for 
two or three days, unless the nurse is directed dif- 
ferently. Fresh dressings and bandages should be Redressing 

J 00 of wound. 

in readiness for the surgeon, as he may desire at 
any time to re-dress the wound. Should any dis- 
charge come through the dressings the surgeon 
should be at once notified of this, as it will be nec- 
essary in such case to change the dressings. The 
same antiseptic precautions should be observed in 
this re-dressing as in the original dressing of the 
wound. 

Inflammation and abscess of the breast may ^^H^ 
sometimes occur as a result of injury or of over- 
distention of the breast with milk during lactation. 
In preparing for the operation of lancing the breast 
the nurse will need to cleanse the breast thoroughly, 
and then wash it with an antiseptic solution and 
apply antiseptic dressings to keep it sterile until 
the time for operation. She should have in readi- 
ness a number of sterilized towels, a pus-pan or 
basin in which to catch the discharges, a tin basin 
containing carbolic solution for the instruments, an 
agate or china basin with a bi-chloride of mercury 
solution for the doctor's hands, soap, nail-brush, 
etc. The patient's clothing should be arranged as 
for amputation of the breast. 

The instruments used will be the bistoury, 
straight or curved, and possibly a probe for subse- 



250 



DISEASES OF WOMEN. 



quent packing of the cavity, with a strip of iodo- 
form gauze. 

Should the surgeon wish to use local anaesthesia 
by means of ice and salt applied to the part, a bowl 
containing a small quantity of salt and a piece of 
smooth ice the size of a small fist, wrapped in a 
towel, so that it can be thus held by the surgeon 
while the application is made, should be provided. 

Fig. 69. 




Bistouries, straight and curved. 



Antiseptic dressings may be applied to the part 
after lancing, or poultices may have, for a time, 
to be kept up. In the latter case the poultice 
should be made by mixing the meal with an an- 
tiseptic solution instead of plain water, in order 
that thorough asepsis may be observed. 

The abscess cavity will probably need to be 
washed out daily with an antiseptic solution and 
the breast re-dressed. 



SPECIAL GYNAECOLOGICAL NURSING. 25 I 

ANAESTHESIA. 

The administration of an anaesthetic, as ether or 
chloroform, does not often devolve upon the nurse \ 
occasionally, however, the physician is obliged 
to call upon the nurse to aid him in this direction ; 
it is therefore important that she should under- 
stand how to conduct the process. For general 
anaesthesia, ether is preferable to anything else 
because it is mucli the safest anaesthetic known. 
Chloroform is dangerous because of its direct 
action upon the heart 

A patient should be prepared for etherization by 
taking nothing into the stomach for several hours 
previously. All the clothing should be loosened, 
false teeth should be removed, and the patient 
placed in a recumbent posture. The patient may 
be made to feel less nervous by one's placing the 
inhaler or towel over her mouth without any ether 
upon it and teaching her to draw deep breaths for 
a few seconds. A small handkerchief, loosely 
folded, may be saturated with about an ounce (two 
tablespoonfuls) of ether and held over the patient's 
mouth and nose, a dry towel being held over this 
to prevent the evaporation of the ether. The eyes 
may be covered by this towel. No talking should 
go on in the room, if possible, as the patient should 
be kept free from excitement. When inhalation 



252 



DISEASES OF WOMEN. 



has fully begun the ether cloth should not be 
removed from the patient's face, but more ether 
added by simply lifting the dry towel and adding 
the ether to the cloth beneath it. Should the 
patient stop breathing for a moment or the face 
become blue, the ether should be removed for a 
moment from the face. When a deep breath has 
been taken, the inhalation should be renewed. 
When during the stage of excitement the patient 
struggles and screams, the ether cloth should be 
held closely to the face, because giving her more 
air will simply make her noisier. The deep inspi- 
rations induced by crying and shouting often 
enable the inhalation to be more quickly effected. 
Retching is another symptom for which the ether 
should not be removed. If, however, the contents 
of the stomach are brought up into the throat and 
mouth, the etherization must be stopped until the 
mouth and throat have been cleared, or there will 
be danger of choking. The ether should be 
stopped for just as short a time as possible. When 
the mouth and throat become filled with an exces- 
sive secretion of mucus, it is also necessary to 
stop for a time and clear this away by carrying the 
finger into the mouth or by turning the patient 
over for a moment on her face or letting her head 
hang down for a moment over the operating table. 
When the patient breathes heavily, the muscles 



SPECIAL GYNAECOLOGICAL NURSING. 253 

are all relaxed, and on lifting the eyelid and touch- 
ing the eye-ball the patient does not flinch, ether- 
ization is complete and the operator will be able to 
begin his work. 

The ether will after this need to be administered 
in very small quantity. When the patient is 
breathing heavily, making a snoring sound (ster- 
torous breathing), the ether should not be pushed, 
but the towel held some distance from the face. 

Whenever ether is administered it should be 
remembered that its vapor is inflammable, and so 
heavy that it falls to the floor, so that any light, as 
a candle or alcohol lamp, should be placed at a 
distance from the operating table and on a higher 
level. 

When breathing ceases entirely and failure of 
the heart seems to threaten, the patient's body 
should be inverted and stimulants, as digitalis, 
atropia, or aromatic spirit of ammonia, used hypo- 
dermically. Every effort should be made to get 
the patient to take a full breath. The tongue 
should be drawn forward out of the mouth, the 
cheeks and chest slapped with a towel wrung out 
in cold water, artificial respiration may be resorted 
to, or the use of electricity. 






254 DISEASES OF WOMEN. 

THE NURSE'S ARMAMENTARIUM. 

A few words may be said in this connection of 
the nurse's armamentarium — the articles she will 
need to take with her to assist in the management 
of the cases she nurses. 

A little pocket-case, containing a clinical ther- 
mometer, straight scissors, sharp-pointed and 
blunt-pointed, a pair of anatomical forceps, a probe, 
and a female catheter, is a convenience. An Eng- 
lish or French male catheter is, also, often a neces- 
sity. Besides these the nurse will need a medicine 
glass, a feeder, and a nail-brush of her own ; pos- 
sibly a wall thermometer or bath thermometer 
might be added to the list, as it may save her 
delay in the use of douches, etc., as ordered, in case 
the family should not have anything of the kind. 

Careful written reports should be kept of each 
case she nurses, and some blanks with the proper 
headings should be carried by her to each case. 
Thus properly equipped, she will be able to work 
more efficiently and satisfactorily to herself and to 
her patient. 



SPECIAL GYNECOLOGICAL NURSING. 



255 



fe 



^ 
I 





DATE. 




HOUR. 




PULSE. 




TEMP. 




RESP. 





O 





g 
w 

n 

3 

g w 
r c 

H 

» 

> 
H 




URINE. 




BOWEL 
MOVE- 
MENTS. 




W 
g 
> 
W 
K 



£ 



> 

a 

> 
s 

o 

o 



o 

H 



> 

CO 

O 
CJ 

H 

C 

*i 

O 

c 

H 



N 



DIET FOR THE SICK. 

LIQUID DIET. 

BARLEY-WATER. 
To one tablespoonful of ground barley add a 
pint of cold water; let it boil twenty minutes. 
Strain and keep in a cool place until used. 

TOAST-MILK. 
Toast two slices of baker's bread a dark brown, 
after drying thoroughly in the oven ; boil a pint 
of milk and pour it over the toast; strain and add 
either a little salt or sugar. Toast water is made 
in the same way, using water instead of milk. 

FLAXSEED TEA. 
To one quart of cold w r ater add one tablespoon- 
ful of flaxseed ; let simmer three or four hours ; 
strain ; add lemon juice and sugar to taste. 

WINE WHEY. 
When a pint of milk is brought just to a boil, 
pour in a gill of sherry wine ; let it again come 
to a boil ; when the whey separates, strain through 
gauze. It may be taken either warm or cold. 

256 



DIET FOR THE SICK. 257 

APPLE-WATER. 
Pare, core, and cut into pieces a large, juicy apple ; 
boil in a pint of water until the apple is tender 
enough to crush to a pulp; strain the liquor and 
sweeten to taste. 

MILK-PUNCH. 

Sweeten a glass three parts full of new milk to 

taste and add one or two tablespoonfuls of brandy 

or whiskey. 

EGG-NOGG. 

Stir well a heaping teaspoonful of sugar and the 
yolk of an egg in a glass and then add a table- 
spoonful of brandy or whiskey ; fill the glass 
with new milk until it is three parts full, then stir 
into the mixture the white of the egg beaten to a 

stiff froth. 

EGG-FLIP. 

One egg, four teaspoonfuls of sugar, a glass three 
parts full of new milk ; beat the egg and sugar 
together until light and stiff, then add to the milk. 

TOAST-WINE. 
One slice of well-browned toast, half a pint of 
boiling water, one teaspoonful of sugar, two 
tablespoonfuls of wine; put the toast into a pitcher, 
pour the boiling water over, and let stand until 
cold ; then strain off the water and to it add the 
sugar and wine. 
17 



258 DISEASES OF WOMEN. 

TODDY. 

Half a glass of water, either hot or cold, half 
a teaspoonful of sugar, four teaspoonfuls of brandy 
or whiskey ; dissolve the sugar in the water and 
add the brandy or whiskey. If the juice of a lemon 
be added it makes lemon-toddy. 

BEEF-TEA. 
To one pint of cold water add one pound of 
chopped lean beef; let boil slowly four hours ; 
strain and salt to taste. 

. QUICK BEEF-TEA. 

One pound of chopped lean beef, half-a-pint of 
cold water, saltspoonful of salt; put the meat, 
water, and salt in a closely covered pan and boil 
gently ten minutes ; stir well, strain, and remove 
the fat. 

BEEF-BROTH. 

One quart of cold water, one pound of lean, 
juicy beef; boil slowly for one hour; add a table- 
spoonful of rice, and salt to taste ; when the rice 
is tender, strain the broth and serve with strips of 
dry toast. 

Mutton broth is made in the same manner. 

Chicken broth requires three pounds of chicken 
to two quarts of cold water. 



DIET FOR THE SICK. 259 

OYSTER BROTH. 

Cut .one pint of oysters into small pieces, put 
them into a saucepan with half a pint of cold water ; 
boil gently ten minutes ; skim, strain, and salt to 
taste. Serve hot with toasted crackers. 

Clam broth is made in the same way. 

EXPRESSED BEEF-JUICE. 
Broil or pan lean beefsteak until it is heated 
through; squeeze the juice out with either a beef 
press or a lemon squeezer ; strain through gauze to 
get the fat off. Before serving warm the juice in a 
small cup placed inside a cup of boiling water. 

TO MAKE COFFEE. 
Mix one tablespoonful of ground coffee with 
enough cold water to form a paste; add one half- 
pint of boiling water ; boil a few minutes, then set 
it back on the range for a few moments to settle. 

TO MAKE TEA. 
Allow one small teaspoonful of tea to each cup ; 
add boiling water. Let the tea-pot stand at the 
side of the fire without boiling for a short time. 

TO MAKE COCOA. 
Mix one teaspoonful of cocoa with enough 
boiling water to form a paste ; add a cupful of 
boiling milk and serve immediately. 



260 



DISEASES OF WOMEN. 



KOUMISS. 
Fill a quart wine bottle up to the neck with pure 
milk ; add a quarter of a cake of compressed yeast 
and two tablespoonfuls of white sugar that have 
been dissolved in a little water over a hot fire. Tie 
the cork in the bottle securely and shake the 
bottle well. Place in a room of a temperature of 
from 50 to 90 F. for six hours, then in the ice- 
box over night. 

SEMI-LIQUID DIET. 

RICE-FLOUR GRUEL. 
Mix two teaspoonfuls of rice flour with four 
tablespoonfuls of cold milk ; pour this into one pint 
of boiling milk, stirring all the time ; boil gently 
for fifteen minutes ; add sugar or salt to taste. 

OATMEAL GRUEL. 

V 

Stir slowly one-half a cupful of rolled oats into 
one pint of boiling water; salt to taste and boil 
for twenty minutes. 



FARINA GRUEL. 
Sprinkle slowly one heaping tablespoonful of 
farina into one pint of boiling water, stirring all the 
time to prevent lumps ; boil for half an hour ; add 
salt to taste. 



DIET FOR THE SICK. 26l 

MEAL BALL. 
Tie a pint of dry flour tightly in a piece of stout 
muslin and boil for nine hours ; scrape off the 
outer crust, and the inside will be found to be a dry 
ball ; grate this as needed, allowing one table- 
spoonful wet in cold milk to a pint of boiling milk; 
boil until smooth; add a salt spoonful of salt. 

CORN-MEAL GRUEL. 
Stir two even tablespoonfuls of corn meal into 
one pint of boiling water ; boil gently for half an 
hour; salt to taste. 

PEPTONIZED FOODS. 

MILK PEPTONIZED BY HEAT. 
Into a clean quart bottle put one measure (5 
grs.) of Fairchild's Extractum Pancreatis, and one 
measure (15 grs.) of bicarbonate of soda, and a gill 
of cold water ; shake ; then add a pint of fresh, cold 
milk and shake the mixture again. Place the 
bottle in water about 1 io° to 115 , or so hot the 
whole hand can be held in it without discomfort 
for a minute. Keep the bottle there twenty 
minutes. # At the end of that time put the bottle on 
ice to check further digestion and keep the milk 
from spoiling. Peptonized milk may be sweetened, 
flavored with grated nutmeg, or taken with mineral 



262 



DISEASES OF WOMEN. 



water. Put the mineral water first into, the glass, 
then quickly pour in the peptonized milk, and 
drink during effervescence. 

MILK PEPTONIZED BY COLD PROCESS. 
Mix the peptonizing powder in cold water and 
cold milk as usual, and immediately place the 
bottle on ice, without subjecting it to the water 
bath or any heat. When needed pour out the 
required quantity and use in the same manner as 
ordinary milk. 

SPECIALLY PEPTONIZED MILK FOR JELLIES, 
PUNCHES, ETC. 

Mix the peptonizing powder (Extractum Pan- 
creatis and bicarbonate of soda), cold water, and 
milk in a bottle, and place in a hot-water bath, as 
directed in recipe for peptonizing milk ; let the 
bottle remain in the hot water for two hours, then 
pour into a sauce-pan and heat to boiling. This 
specially peptonized milk is now ready for jellies, 
etc. In peptonizing milk for recipes in which 
lemon juice or acid is to be used, it is necessary to 
carry the process to the point at which the milk 
will not curdle with acid. Hence the two hours' 
digestion. Do not faU to boil the milk, immedi- 
ately after the two hours in water bath, otherwise 
the milk will not set into a jelly, as the powder 
would digest the gelatine. 



DIET FOR THE SICK. 263 

PEPTONIZED MILK JELLY. 
First take about half a box of Nelson's gelatine, 
and set it aside to soak in a teacupful of cold water 
until needed; take one pint of specially pepto- 
nized milk heated hot ; pare one lemon and one 
orange and throw the rinds into the specially pre- 
pared milk; squeeze the lemon and orange juice 
into a glass, strain, and mix it with two or three 
tablespoonfuls of wine or brandy ; add to the milk, 
stirring well ; strain through gauze, and when 
cooled to a sirupy consistency, so as to be almost 
ready to set, pour into moulds and set in a cool 
place. Do not pour the milk into the moulds 
until it is nearly cool, otherwise it will separate in 
setting. 

PEPTONIZED MILK-PUNCH. 
Take a glass about one-third full of fine crushed 
ice, pour on it a tablespoonful of brandy or whiskey, 
sweeten slightly and fill the glass with peptonized 
milk, stirring well. 



MILK LEMONADE. 
Take a glass one-third full of cracked ice; squeeze 
on it the juice of a lemon, sweeten to taste, and fill 
the glass with specially peptonized milk. 



264 DISEASES OF WOMEN. 

MILK-GRUEL. 
Mix smoothly a heaping teaspoonful of wheat 
flour or arrowroot with half a pint of cold water ; 
then heat, with constant stirring until it has boiled 
briskly, several minutes ; mix with this hot gruel 
one pint of cold milk, and strain into a jar and 
immediately add one peptonizing powder ; mix 
well. Let it stand in the hot water bath for 30 
minutes, then put into a clean quart jar and place 
on ice. 

PEPTONIZED BEEF. 
One quarter of a pound of minced raw beef or 
beef and chicken mixed, or chicken alone ; cold 
water one-half pint ; cook over a slow fire, stirring 
constantly, until it has boiled a few minutes, then 
pour off the liquor and rub the meat to a paste, 
put it into a jar with one-half pint of cold water 
and the liquor poured from the meat, add four 
measures, or 20 grs., of Extractum Pancreatis, and 
one measure, or 15 grs., bicarbonate of soda ; shake 
all well together and set aside in a warm place at 
about 110 or 1 1 5 ° F. for three hours, shaking 
occasionally, then boil quickly, strain and season. 
Be sure to boil the peptonized beef after three 
hours in a warm place, otherwise the digestion will 
progress until it is spoiled. 



DIET FOR THE SICK. 265 

PEPTONIZED OYSTERS. 

Half dozen large oysters with their juice and 
half pint of cold water ; put into a saucepan and 
boil briskly for a few minutes ; strain off the broth 
and set aside ; mince the oysters and rub them to 
a paste; now put the oysters in a glass jar with 
the juice which has been set aside, and add three 
measures, or 15 grs., of Extractum Pancreatis, and 
one measure, or 15 grs., of bicarbonate of soda; 
let the jar stand in hot water, 1 1 5 ° F., for one and 
a half hours ; pour into a saucepan, add half a 
pint of milk, and heat over the fire slowly to boil- 
ing point ; strain, and season with salt and pepper. 
Heating the mixture slowly digests the milk suffi- 
ciently before the mixture boils. For a great major- 
ity of cases it will not be required to strain the 
peptonized liquor, for the portion of meat remain- 
ing undissolved will have been so softened and 
acted upon by the pancreatic extract that it will be 
in very fine particles, and diffused in an almost 
impalpable condition. 

Farinaceous materials may also be used advan- 
tageously in the preparation of the peptonized soup 
by simply boiling a sufficient quantity of flour, 
arrowroot, rice, etc., with a half portion of the 
water used in the above recipe, and mixing all 
together, meat, gruel, Extractum Pancreatis, and 



266 DISEASES OF WOMEN. 

soda. The pancreatine will at the same time digest 
both starch and meat. This has a more agreeable 
flavor than that made of meats alone. Jelly may 
also be made of peptonized beef. Beef-tea is pep- 
tonized in the same way as milk, using one pint of 
carefully strained cold beef-tea. 



FARINACEOUS FOODS. 

ARROWROOT CUSTARD. 
Mix four tablespoonfuls of Bermuda arrowroot 
with one gill of cold milk, and pour it slowly into 
one pint of boiling milk, stirring all the time ; add 
two teaspoonfuls of sugar, a pinch of salt, and cook 
for fifteen minutes; flavor with nutmeg or ten drops 
of brandy; pour it into a mould to cool. Serve 
with cream. 

ARROWROOT WINE JELLY. 
Mix two tablespoonfuls of Bermuda arrowroot 
with four tablespoonfuls of cold water and strain 
through gauze into half a pint of boiling water, 
stirring all the time ; add two teaspoonfuls of sugar 
and simmer for five minutes, or until it looks per- 
fectly clear ; remove from the fire, and stir in two 
tablespoonfuls of wine or brandy. Pour into a 
mould to cool. 



DIET FOR THE SICK. 267 

ARROWROOT GRUEL. 

Mix one tablespoonful of Bermuda arrowroot, a 

pinch of salt, and half a gill of cold water; stir into 

half a pint of boiling water and boil for fifteen 

minutes. 

TAPIOCA JELLY. 

Wash one tablespoonful of tapioca thoroughly 
and soak it in three gills of cold water over night, 
then simmer slowly until clear ; add five teaspoon- 
fuls of sugar and two teaspoonfuls of lemon juice 
and turn into a mould. 

TAPIOCA CUSTARD. 
One tablespoonful of tapioca soaked in two gills 
of cold -water over night ; boil until clear ; put one 
gill of milk into a double kettle ; beat together one 
egg, one teaspoonful of sugar, one half teaspoonful 
of corn-starch, and add to the gill of boiling milk ; 
boil until about the consistency of cream ; take from 
the fire and pour it into a bowl to cool ; when cool 
stir in the stiff beaten white of an egg and the 
tapioca, and serve cold. Sago can be used in place 
of tapioca if desired. 

FARINA CUSTARD. • 
Into two gills of boiling milk sprinkle one table- 
spoonful of farina, stirring all the time ; boil for 
twenty minutes ; then add the beaten yolk of one 



268 



DISEASES OF WOMEN. 



egg and one teaspoonful of sugar; let boil again 
and stir in the stiff beaten white of the egg ; take 
from the fire, add a few drops of lemon or vanilla, 
if allowed, and turn out to cool. 



EASILY PREPARED DESSERTS FOR CONVALES- 
CENTS. 

RICE SNOW. 

Wash one tablespoonful of rice and boil until 
tender in a double boiler ; add one tablespoon- 
ful of milk, one teaspoonful of sugar, a few drops 
of vanilla; while boiling stir in the stiff beaten 
white of one egg. Serve with cream either hot or 
cold. 

* BREAD PUDDING. 

Put one gill of dry bread crumbs into a small 
baking dish ; pour two gills of boiling milk over 
them, cover close, and set aside to cool ; beat 
together one heaping teaspoonful of sugar and one 
egg until very light, and stir into the bread and 
milk, which should be nearly cold ; flavor with 
nutmeg and bake in a quick oven for twenty 
minutes. Serve hot with cream. 



PLAIN RICE PUDDING. 
Wash one-third of a cup of rice well ; butter a 
pudding dish and stir in the rice, one pint of milk, 



DIET FOR THE SICK. 269 

and one tablespoonful of sugar ; add a pinch of salt ; 
grate nutmeg over it and bake for one and a half 
hours. 

CORN-STARCH PUDDING. 
Boil two gills of milk in a double kettle ; dis- 
solve one tablespoonful of corn-starch in a little 
cold milk and add to the boiling milk ; boil for five 
minutes and then add the beaten yolk of one egg, 
one teaspoonful of vanilla, and one tablespoonful of 
sugar; turn into a buttered dish and bake in the 
oven for fifteen minutes ; beat the white of the 
egg and a tablespoonful of pulverized sugar 
together until very light, spread over the pudding, 
and brown lightly in the oven. Instead of adding 
the yolk and baking the pudding, after adding the 
sugar and flavoring, stir in the well-beaten white of 
the egg, turn into a wet cup, and serve in a custard 
made of the yolk in this way : into one gill of 
boiling milk stir one half teaspoonful of corn-starch 
dissolved in one tablespoonful of milk ; add the 
well-beaten yolk of the egg and one half teaspoon- 
ful of sugar ; boil for five minutes ; flavor with lemon 
or vanilla. 

TIPSY PUDDING. 
Half fill a small glass dish with stale sponge cake ; 
mix together a tablespoonful of wine and table- 
spoonful of boiling water, and pour over the cake; 



27O DISEASES OF WOMEN. 

then fill the dish with custard made according to 
above recipe. 

GERMAN TRIFLES. 
In a small glass dish place a thin layer of sponge 
cake, then a layer of sliced orange, and pour 
custard over it. The white of the egg and one 
tablespoonful of pulverized sugar beaten very light 
may be piled on top when ready to serve. 

APPLE FLOAT. 
Stew and strain one large, tart apple ; when cold 
add a tablespoonful of sugar and the well-beaten 
white of one egg. Serve as soon as made. 

APPLE CUSTARD. 
Stew and strain one large, tart apple ; place over 
the fire, and while boiling add the beaten white of 
an egg and sugar to taste; place on ice, and before 
serving pile the beaten white and pulverized sugar 
on top of the custard. Serve with cream. 

TAPIOCA AND FRUIT. 
Wash a tablespoonful of tapioca and soak over 
night in three gills of cold water; then cook slowly 
until smooth and clear; add the juice of half a 
lemon, a teaspoonful of vanilla, and sugar to taste ; 
place about a dozen large strawberries in a dish 



DIET FOR THE SICK. 2*]\ 

and pour the hot tapioca over them; then put on 
ice until ready to serve. Sliced peaches, rasp- 
berries, or bananas can be used in the same 
manner. 

EGG JUNKET. 
Beat one egg very light ; add one teaspoonful of 
sugar, one half teaspoonful of vanilla, and two gills 
of lukewarm milk ; put it into the dish it is to be 
served in and stir in one teaspoonful of rennet. 

CHOCOLATE PUDDING. 
Make a corn-starch pudding according to recipe 
given ; when sufficiently boiled add one tablespoon- 
ful of grated chocolate ; put the white of egg beaten 
stiff with one tablespoonful of pulverized sugar on 
top and brown slightly in oven. 



WHIPPED CREAM. 
Mix together two gills of rich cream, one half 
cup pulverized sugar, two tablespoonfuls sherry 
wine; put on ice for an hour, as cream whips much 
better if chilled; whip with an egg beater, and as 
the froth rises skim it off and lay it on a sieve to 
drain, returning the cream which drips away to be 
whipped over again. Place on the ice a short time 
before serving. 



272 DISEASES OF WOMEN. 

LEMON JELLY. 
Cover one-third of a box of Nelson's gelatine 
with cold water and let it soak for fifteen minutes ; 
then add one cup of sugar, juice of one lemon, 
and two gills of boiling water ; stir until the sugar 
is dissolved ; strain through gauze and stand on ice 
to harden. 

WINE JELLY. 
Wine jelly is made the same, adding one gill of 
port or sherry wine instead of lemon juice. 

ORANGE FLOAT. 
Moisten one tablespoonful of corn-starch with a 
little cold water and stir it into two gills of boiling 
water, stirring constantly ; add one tablespoonful 
of sugar and the juice of one lemon; cut two 
oranges into small pieces, put into a dish, and 
pour the boiling corn-starch over them ; put on 
ice until needed. 

TOUT FAIT. 
Beat the yolk of an egg and a tablespoonful 
of sugar to a cream ; add one tablespoonful of 
milk and one of flour ; beat until smooth ; add 
the juice and rind of a lemon and the white of 
the egg beaten to a stiff froth ; turn into a but- 
tered cup, dredge the top of the custard thickly 



DIET FOR THE SICK. 273 

with pulverized sugar, and bake in a quick oven 
for fifteen minutes. 

STRAWBERRY SPONGE. 

Cover one-half box of Nelson's gelatine with cold 
water and soak for half an hour, then pour over 
it one pint of boiling water ; add one-half cup of 
sugar and stir until dissolved ; add one-half pint 
of strawberry juice and strain into a basin ; put 
this basin into a pan of cracked ice to stand 
until cold and stiff, stirring occasionally; then 
beat to a stiff froth, add the well-beaten whites 
of four eggs, beat until smooth ; then place on the 
ice to harden. 

CUP CUSTARD. 

Beat one egg until light ; add one teaspoonful of 
sugar; beat again; add one and a half gills of milk 
and nutmeg to taste and stir until the sugar is dis- 
solved ; pour into a buttered cup, place the cup 
in a pan of boiling water, and place in the oven. 
Bake until the custard sets ; then set away to 
cool. 

MISCELLANEOUS RECIPES. 

BAKED POTATOES. 
Select potatoes of same size ; wash them well ; 
bake in a clean, hot oven from 30 to 40 minutes, 
or until soft ; break the skins to let the steam in- 
side escape. Serve as soon as done. 
18 



274 DISEASES OF WOMEN. 

CROUTONS. 

Cut stale bread into half-inch slices ; cut off the 
crust and cut into half-inch cubes ; put them on a 
shallow pan and bake until brown. Use with beef- 
tea or broth. 

BAKED APPLES. 

Wipe the apples, remove the core, and put them 
in a pan; put sugar in the centre of each apple 
and enough water to cover the bottom of the pan ; 
bake in a hot oven until soft, but not broken. 

BAKED CRACKERS. 
Split round crackers in halves, spread the inside 
with butter ; put them buttered side up into a pan 
and brown in a hot oven. 

BOILED POTATOES. 
Select potatoes of nearly same size ; wash them 
well ; pare and cover with cold water ; put them in 
a saucepan of boiling salted water (allowing one 
quart of water and one tablespoon even full of 
salt for six large potatoes) ; cook one-half hour or 
until soft ; drain off every drop of water and place 
the saucepan uncovered at the back of the stove 
to let the steam escape. Serve hot. 

RICE POTATO. 
Mash the potatoes as soon as they are boiled, 
and press them through a colander into a hot dish. 



DIET FOR THE SICK. 275 

MASHED POTATO. 
To one pint of hot boiled potatoes add one table- 
spoonful of butter, one-half teaspoonful of salt, 
and enough hot milk to moisten ; mash in the 
saucepan they were boiled in and beat with a fork 
until light and creamy ; then turn into a hot dish. 

POTATO CAKES. 

Make cold, mashed potatoes into small, round 
cakes about one-half inch thick ; put them into a 
baking pan, brush them over with milk, and bake 
in a hot oven until brown. 

HARD-BOILED EGGS. 

Cook them twenty minutes in water just bub- 
bling ; then the yolk is dry, mealy, and easily di- 
gested. 

BOILED CUSTARD. 

Beat one egg to a froth ; add one tablespoonful 
of sugar and a little salt ; mix well ; add one cup 
of scalded milk and stir over boiling water until it 
thickens. Serve cold. 

WATER TOAST. 

Dip a slice of dry toast in salted boiling water; 
spread with butter and serve very hot. 



276 DISEASES OF WOMEN. 

MILK TOAST. 

Dip a slice of dry toast in boiling milk which 
has a piece of butter dissolved in it. 

BROILED STEAK. 

Remove the bone and cut off the fat of a tender 
piece of steak; broil over a clear fire, turning the 
broiler every ten seconds ; if it is to be rare, cook 
for four minutes. Serve on a hot plate with but- 
ter, salt, and pepper. 

PANNED MUTTON CHOP. 

Have the frying-pan hissing hot without any fat ; 
take off the pink skin and outer fat of a chop, put 
it in the pan, and cook one minute ; turn and sear on 
the other side, then cook more slowly until done — if 
rare, five minutes will be long enough ; when 
nearly done, sprinkle a little salt on each side. 
Drain on paper and serve very hot on a very hot 
plate without a drop of grease. 

BAKED APPLE SAUCE. 

Fill a small baking dish with apples, pared, 
cored, and quartered ; allow one-half cup of sugar 
for one quart of apples, also one cup of water ; 
bake, covered, in a slow oven until clear. 



DIET FOR THE SICK. 277 

STEWED PRUNES. 
Wash one pound of prunes and soak them for 
one hour before cooking ; put them in a granite 
pan and cover with boiling water ; simmer until 
swollen and tender, then add one tablespoonful of 
sugar ; cook ten minutes longer and set away to 
cool. 

STEWED OYSTERS. 
Put a pint of oysters in a pan and heat until the 
edges curl ; then add one cup of boiling milk that is 
salted to taste ; butter and pepper may be added 
if allowed. 

STEWED CRANBERRIES. 
Wash and pick one cup of cranberries ; put them 
in a saucepan and sprinkle one-half cup of sugar 
over them ; pour out one-fourth cup of water, and 
after they begin to boil cook them for ten minutes, 
closely covered ; do not stir them. They will jelly 
when cold and are much nicer than when strained. 



STEAMED RHUBARB. 
Wash enough rhubarb cut into inch pieces to 
fill a cup ; put it into a double boiler; sprinkle one- 
half cup of sugar over it and steam until soft. Do 
not stir it. 



278 DISEASES OF WOMEN. 

BROILED FISH. 

To broil mackerel, white fish, small blue fish, 
trout, small cod, shad, or any other thin fish, split 
them down the back and remove the head and tail. 
Sometimes it is well to remove the backbone also. 
To broil halibut, salmon, and other thick fish, cut 
them into inch-thick slices across the back-bone 
and remove the bone and skin. Oily fish need 
only salt and pepper, but dry white fish should be 
spread with soft butter before broiling. 

Grease a double wire broiler with lard or butter ; 
put the thickest edge of the fish next the middle 
of the broiler ; broil the flesh side first until it is 
brown, lifting it up often that it may not burn ; cook 
the other side enough just to crisp the skin — the 
time will vary with the thickness of the fish ; the 
flesh when done should look firm and white and 
separate easily from the bone ; loosen the fish from 
each side of the broiler, open the broiler and slide 
off the fish, or hold a plate over the skin side of 
the fish and invert plate and broiler together ; season 
with pepper and salt. 

SAUCE FOR FISH. 

Put a pint of water in a saucepan ; add half-tea- 
spoonful of salt ; mix one-half cup of butter and 
two tablespoonfuls of flour together; when per- 



DIET FOR THE SICK. 279 

fectly smooth, add to the boiling water, stir rapidly 
until it thickens — if not free from lumps strain the 
sauce. To make egg sauce, add to the drawn butter 
two hard-boiled eggs, sliced, or one tablespoonful 
of finely chopped parsley may be added. 



28o DISEASES OF WOMEN. 



WEIGHTS AND MEASURES. 

FLUID MEASURE. 

f^viij ^r fgj 

f g xvj = Oj 

Oviij = Cj. 

APOTHECARIES' MEASURE, 
gr.xx = 9J 

B li J — si 

£ vii J = SJ 

gxij = lb.j. 

DOMESTIC MEASURES. 

I teaspoonful, about one fluidrachm == f^j 

I tablespoonful, " y z fluidounce = f^ ss 

I wineglassful, " 2 fluidounces = f § ij 

I teacupful, " 4 fluidounces = ^E lY 

I coffeecupful, " 8 fluidounces = fg viij. 



INDEX. 



A BORTION, induction of, 171 

■**■ Abdominal section, causes 
42, 43 
preparation for, 90-98 
articles needed for, 57-59 
clothing needed for, 54- 

Abstinence from food, 95, 214 

Anaesthesia, 251 

Anaesthetic, administration of, 251- 

Antisepsis, definition of, 30 

Antiseptic solutions, 208 
strength of, 209 

Asepsis, definition of, 30 

Apple water, 257 

Apple float, 270 

Apple custard, 270 

Applicators, 198 

Armamentarium, 254 

Arnold steam sterilizer, 33 

Arrowroot custard, 266 
gruel, 267 
wine jelly, 266 

Aspirator, 242, 243 



TDACTERIA, definition of, 25 
•*-' diseases due to, 26 

growth of, 26 

pyogenic, 28 

security against, 29 

uses of, 29 

varieties of, 27 
Barley water, 256 
Baked apples, 274 

crackers, 274 

potatoes, 273 

apple sauce, 276 
Beef tea, 258 

broth, 259 

juice expressed, 259 
Bandage, abdominal, 133, 134 

many-tailed, 77, 78 

" T," 210 
Bed, arrangement of, 55, 56 

warming of, 63, 103 



for, 



253 



Bedding, changing of, 130-133 

Bedpan, 121 

Bed cradle, 146 

Bedsores, prevention of, 123 

Bathing, 176, 214 

after operation, 128 
Bladder, washing out of, 153 

care of, 169 

evacuation of, 94 
Blood poisoning, 112 
Bowels, care of, 169, 178 

evacuation of, 214 
Boiled custard, 275 

potatoes, 274 
Broiled steak, 276 

fish, 278 
Breast, abscess of, 249, 250 

amputation of, 247, 248 
care after, 249 
Breath, care of, 23 



CARRIERS, 84 
Catheter, use of, 



116, 



17 



return, 154 

S-shaped, 234 

bulbous, 234 
Catheterization, 226 
Carunculae myrtiformes, 159 
Caruncle urethral, operation for, 238 
Care of soiled clothing, 104 

after minor operations, 222 
Clothing for minor operations, 214 

changing, 129 
Clitoris, 157 
Cleanliness, surgical, 19 

personal, 19 
Conception, 163 

prevention of, 171 
Costume of nurse, 19-21 
Counter-irritation, 187, 188 
Curetting of uterus, 244 
Cystitis, 152, 153, 237 
Convalescents, desserts for, 268-273 
Chocolate pudding, 271 



28l 



282 



INDEX. 



Corn starch pudding, 269 
Cup custard, 273 
Coffee, to make, 259 
Cocoa, to make, 259 

T"\IET for sick, 256, 280 
*~^ liquid, 256-260 

semi-liquid, 260, 261 

after operation, 113-115 

management of, 174-176 
Dilatation of uterus, 244 
Disease, pelvic, 164 

causes of, 164-172 

management of, 173 

symptoms of, 173 

history of, 190, 191 
Disinfection of clothing, 19-21, 36 

of discharges, 36 

of furniture, 37 

of hands, 19-22, 99, 100 

of patient, 38, 92 

of room, 37, 38 

of waste matter, 35 

of wounds, deep, 34 
open, 38 
surface, 34 

of vagina, 215 

of vulva, 215 
Discharge, vaginal, 224 
Domestic measures, 280 
Drainage tube, 125 

capillary, 82, 128 

method of, 125-127 
Dressings, surgical, 39 

special, 77 

application of, 220 
Drying powders, 77, 78 
Duties of nurse during operation, 
102-105, 219-222 

after operation, 106, 222, 256 



■pGG FLIP, 257 
■*-' junket, 271 

nogg, 257 
Electricity, 177 
Elytrorrhaphy, 230 
Embolism, 151 
Enemata, stimulating, 109 

moving, 119, 120 
Examination, preparation for, 191, 203 

instruments for, 194-199 
Exercise, 176 

PARINACEOUS FOOD, 266-268 
■*■ Farina custard, 267 
Fever cot, 137 



Fistula, definition of, 232 

examination for, 233 

healing of, 233 

symptoms of, 233 

varieties of, 232, 233 

vesico-vaginal, 233 

operation for, 233 

care after, 234-236 

secondary operation, 236 

recto-vaginal, 237 

operation for, 237, 238 
Flaxseed tea, 256 
Forced feeding, 174 
Forceps, cyst, 87 

dressing, 198 

pressure, 85 

"T," 87 
Fourchette, 159 
Furniture, arrangement of, 54, 55 

muffling of, 56, 57 

sterilization of, 37 



/"VAUZE, bichloride, 39, 40 
^■* iodoform, 76, 77 

storing of, 77 
Genitalia, external, 157 

internal, 157 
Germicides, 34 
German trifles, 270 
Grooved director, 87 
Gruel, cornmeal, 261 

farina, 260 

oatmeal, 260 

rice flour, 260 



XJANDS, care of, 21 
■*■* Hard-boiled eggs, 275 
Hair, arrangement of, 92 
Hemorrhage, period of danger, 112 

internal, 147 

primary, 112, 147 

management of, 147, 148 

secondary, 112 

symptoms of, 112, 147 
Hemorrhoids, operation for, 240,241 

care after, 240, 241 

palliative treatment of, 241 
Hygiene, 165, 166 
Hymen, 159 
Hysterectomy, 45 

vaginal, 245, 246 



TCE CAP, Thornton's, 140 
**■ rubber, 138 
Ignition tubes, 82 



INDEX. 



283 



Inhibitory agents, 34 
Injections, vaginal, 90, 179 

antiseptic, 94 

method of giving, no, in, 179, 
186 
Instruments for abdominal section, 

85-89 
pelvic examination, 194-199 
Intra-uterine syringe, 244, 245 
Irrigation, 65, 66 
Irrigator, 184 
Infection, 28 
Inflammation, 112 



K 



OUMISS, 260 



T ABIA, 157 
- 1 -"* Leg holder, 216 
Leiter's tubes, 138 
Lemon jelly, 272 
Ligament, broad, 161 
Ligature, definition of, i. 
material for, 80 
passage of, 156 
preparation of, 81, S 
sterilization of, 80 
storing of, 80 



TV/TASSAGE, 177 
1VA Meatus, 157 
Measure, apothecaries', 28 

fluid, 280 

domestic, 280 
Meal ball, 261 
Menstruation, 156-162 

suppressed, 169 
Milk punch, 257 
Mons veneris, 157 



N 1 



[EEDLE HOLDER, 83 
1 Needles, threading, 83 
Nervous overstrain, 170 
Nurse, qualifications of, 17 

necessity for training, 18 
Nymphse, 157 



OBSTRUCTION, intestinal, 14 
^ prevention of, 148 

treatment of, 149 
Occlusion dressing, 211, 212 
Office oven, 31 



Orange float, 272 
Oyster broth, 259 
Operations on bladder, 48 

on gall-bladder, 48 

intestines, 46, 47 

kidneys, 47 

liver, 47 

mesentery, 48 

omentum, 48 

pancreas, 48 

spleen, 47 

stomach, 46 

tubes and ovaries, 45 

uterus, 45, 46 

pelvic, 204, 256 

minor, preparations for, 204 
preparations, table for, 205 
arrangement of bed for, 20; 
208 

for pelvic abscess, 242, 243 

for stone in bladder, 241, 242 
Ovaries, 161 



pANNED MUTTON CHOP, 276 

•*■ Peptonized foods, 261-266 

milk (hot process), 261 
(cold process), 262 
for jellies, etc., 262 
for gruel, 264 
jelly, 263 
lemonade, 263 
punch, 263 

beef, 264 

oysters, 265 
Parotitis, 151 
Pedicle ligature, 84 

needle, 88 

pins, 88 
Perineum, 159 
Perineorrhaphy, 223 

preparation for, 223 

arrangement for, 224 

after care, 225, 226 

removal of sutures in, 229 
Peritonitis, symptoms of, 142 

treatment of, 146 
Pessaries, 187 
Phlegmasia, 150 
Position, 200-^03 

dorsal, 216 

knee-chest, 218 

Sims', 216 
Puberty, 162, 163 
Pyaemia, 142 

Protection of patient, 217 
Potato cakes, 275 

mashed, 275 



284 



INDEX. 



Pudding, plain rice, 268 
bread, 268 



RECORD OF TEMPERA- 
TURE, 113 

special symptoms, 113-119 
Reform dress wear, 166-168 
Retractor, 88 
Rice potato, 274 

snow, 268 
Room, arrangement of, 53, 54 

fumigation of, 51, 52 

location of, 49, 50 

preparation of, 50-53 

OAL1NE PURGATIVE, 91 
^ Sauce for fish, 278, 279 
Scalpels, 84 
Septicaemia, 142 

symptoms of, 143 

treatment of, 143 
Serre-noeud, 88 
Shock, 106, 107 
Sleep, 177 
Sound, uterine, 195 
Specula, 195 

bivalve, 195, 196 

cylindrical, 196 
Speculum, Sims', 197 
Sponges, artificial, 72 

diseased, 68 

discolored, 70 

counting, 71 

flat, 71, 72 

mounted, 71, 218 

preparation of, 68-70 

storing of, 70 

varieties of, 67 

management of, i<"3, 220 
Stomach, washing out, 143 
Sterilization of bedding, 36 

clothing, 31, 55, 75 

instruments, 31-40 

ligatures, 80, 81 

living tissues, 33 

water, 33 

by use of antiseptics, 75 
dry heat, 73 
moist heat, 73 
Stitch abscesses, 149 
Surgical apron, 100 
Syringe, hypodermic, 107 

care of, 107 



Syringe, use of, 108 

Davidson's, no 

fountain, 180 
Steamed rhubarb, 277 
Stewed cranberries, 277 

oysters, 277 

prunes, 277 
Strawberry sponge, 273 



q^AMPON, vaginal, 186, 187 
"*■ Tetanus, 155 
Thrombosis, 149, 150 
Temperature, rise of, 136 

reduction of, 136-142 
Thermo-cautery, 233-240 
Trachelorrhaphy, 231 

preparation for, 231 

after care, 231 
Trismus, 155 
Trocar and cannula, 86 
Tubes, Fallopian, 161 

drainage, 125 
Tapioca and fruit, 270 

custard, 267 

jelly, 267 
Tea, to make, 259 
Toast milk, 256 

wine, 257 
Tout fait, 272 
Tipsy pudding, 269 
Toddy, 258 



TTRETER, closure of, 237 
^ Urine, character of, 118 
Urinals, 117, 118 
Uterus, 160, 161 



T7AGTNA, 158 
V Vestibule, 157 
Volsella, 86 
Vomiting after ether, 115 



\X7ATER coils, 140 
** Weights and measures, 280 
"Whites," 160 
Wounds, redressing, 249 
Water toast, 275 
Whipped cream, 271 
Wine jelly, 272 

Wine whey, 256 



CATALOGUE No. 7. 



SEPTEMBER, 1891. 



A CATALOGUE 

OF 

Books for Students. 



INCLUDING THE 



? QUIZ-COMPENDS ? 



CONTENTS. 




PAGE 




PAGE 


New Series of Manuals, 2,3,4,5 


Obstetrics. . 


. IO 


Anatomy, 


6 


Pathology, Histology, 


. II 


Biology, 


11 


Pharmacy, . 
Physical Diagnosis, 


. 12 


Chemistry, . 


6 


. II 


Children's Diseases, . 


7 


Physiology, . 


. II 


Dentistry, 


8 


Practice of Medicine, 


. II, 12 


Dictionaries, 


8 


Prescription Books, 


. 12 


Eye Diseases, 
Electricity, . 


9 


?Quiz-Compends ? 


• Mi *5 


9 


Skin Diseases, 


. 12 


Gynaecology, 


10 


Surgery, 


• !3 


Hygiene . 


9 


Therapeutics, 


. 9 


Materia Medica, . 


■ 9 


Urine and Urinary Org 


ans, 13 


Medical Jurisprudence, 


10 


Venereal Diseases, 


• J 3 



PUBLISHED BY 



P. BLAKISTON, SON & CO., 

Medical Booksellers, Importers and Publishers. 

LARGE STOCK OF ALL STUDENTS' BOOKS, AT 
THE LOWEST PRICES. 

1012 Walnut Street, Philadelphia. 



*** For sale by all Booksellers, or any book will be sent by mail, 
postpaid, upon receipt of price. Catalogues of books on all branches 
of Medicine, Dentistry, Pharmacy, etc., supplied upon application. 

j®^ Gould's New Medical Dictionary Just Ready. See page 16. 



"An excellent Series of Manuals." — Archives of Gynecology. 

A NEW SERIES OF 

STUDENTS' MANUALS 

On the various Branches of Medicine and Surgery. 

Can be used by Students of any College. 

Price of each, Handsome Cloth, $3.00. Full Leather, $3.50. 

The object of this series is to furnish good manuals 
for the medical student, that will strike the medium 
between the compend on one hand and the prolix text- 
book on the other — to contain all that is necessary for 
the student, without embarrassing him with a flood of 
theory and involved statements. They have been pre- 
pared by well-known men, who have had large experience 
as teachers and writers, and who are, therefore, well 
informed as to the needs of the student. 

Their mechanical execution is of the best — good type 
and paper, handsomely illustrated whenever illustrations 
are of use, and strongly bound in uniform style. 

Each book is sold separately at a remarkably low 
price, and the immediate success of several of the 
volumes shows that the series has met with popular 
favor. 

No. 1. SURGERY. 236 Illustrations. 
A Manual of the Practice of Surgery. By Wm. J. 
Walsham, M.D., Asst. Surg, to, and Demonstrator of 
Surg, in, St. Bartholomew's Hospital, London, etc. 
236 Illustrations. 

Presents the introductory facts in Surgery in clear, precise 
language, and contains all the latest advances in Pathology, 
Antiseptics, etc. 

" It aims to occupy a position midway between the pretentious 
manual and the cumbersome System of Surgery, and its general 
character may be summed up in one word — practical." — The Medi- 
cal Bulletin. 

"Walsham, besides being an excellent surgeon, is a teacher in 
its best sense, and having had very great experience in the 
preparation of candidates for examination, and their subsequent 
professional career, may be relied upon to have carried out his 
work successfully. Without following out in detail his arrange- 
ment, which is excellent, we can at once say that his book is an 
embodiment of modern ideas neatly strung together, with an amount 
of careful organization well suited to the candidate, and, indeed, to 
the practitioner." — British Medical Journal. 

Price of each Book, Cloth, $3.00 ; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 2. DISEASES OF WOMEN. 150 Illus. 

NEW EDITION. 

The Diseases of Women. Including Diseases of the 
Bladder and Urethra. By Dr. F. Winckel, Professor 
of Gynaecology and Director of the Royal University 
Clinic for Women, in Munich. Second Edition. Re- 
vised and Edited by Theophilus Parvin, m.d., 
Professor of Obstetrics and Diseases of Women and 
Children in Jefferson Medical College. 150 Engrav- 
ings, most of which are original. 
" The book will be a valuable one to physicians, and a safe and 

satisfactory one to put into the hands of students. It is issued in a 

neat and attractive form, and at a very reasonable price." — Boston 

Medical and Surgical Journal. 

No. 3. OBSTETRICS. 227 Illustrations. 
A Manual of Midwifery. By Alfred Lewis Galabin, 
M.A., M.D., Obstetric Physician and Lecturer on Mid- 
wifery and the Diseases of Women at Guy's Hospital, 
London; Examiner in Midwifery to the Conjoint 
Examining Board of England, etc. With 227 Illus. 
" This manual is one we can strongly recommend to all who 
desire to study the science as well as the practice of midwifery. 
Students at the present time not only are expected to know the 
principles of diagnosis, and the treatment of the various emergen- 
cies and complications that occur in the practice of midwifery, but 
find that the tendency is for examiners to ask more questions 
relating to the science of the subject than was the custom a few 
years ago. * * * The general standard of the manual is high ; 
and wherever the science and practice of midwifery are well taught 
it will be regarded as one of the most important text-books on the 
subj ect.' ' — London Practitioner. 

No. 4. PHYSIOLOG-Y. Fifth Edition. 

321 ILLUSTRATIONS AND A GLOSSARY. 
A Manual of Physiology. By Gerald F. Yeo, m.d., 

f.r.c.s., Professor of Physiology in King's College, 

London. 321 Illustrations and a Glossary of Terms. 

Fifth American from last English Edition, revised and 

improved. 758 pages. 

This volume was specially prepared to furnish students with a 
new text-book of Physiology, elementary so far as to avoid theories 
which have not borne the test of time and such details of methods 
as are unnecessary for students in our medical colleges. 

"The brief examination I have given it was so favorable that I 
placed it in the list of text-books recommended in the circular of the 
University Medical College." — Prof. Lewis A. Stimson, m.d., 
37 East 33d Street, New York. 

Price of each Book, Cloth, $3.00; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 5. DISEASES OP CHILDREN. 

SECOND EDITION. 

A Manual. By J. F. Go©dhart, m.d., Phys. to the 
Evelina Hospital for Children ; Asst. Phys. to 
Guy's Hospital, London. Second American Edition. 
Edited and Rearranged by Louis Starr, m.d., Clinical 
Prof, of Dis. of Children in the Hospital of the Univ. 
of Pennsylvania, and Physician to the Children's Hos- 
pital, Phila. Containing many new Prescriptions, a list 
of over 50 Formulae, conforming to the U. S. Pharma- 
copoeia, and Directions for making Artificial Human 
Milk, for the Artificial Digestion of Milk, etc. Illus. 

" The merits of the book are many. Aside from the praiseworthy 
work of the printer and binder, which gives us a print and page 
that delights the eye, there is the added charm of a style of writ- 
ing that is not wearisome, that makes its statements clearly and 
forcibly, and that knows when to stop when it has said enough. 
The insertion of typical temperature charts certainly enhances the 
value of the book. It is rare, too, to find in any text-book so many 
topics treated of. All the rarer and out-of-the-way diseases are 
given consideration. This we commend. It makes the work 
valuable." — Archives of ' Pedriatics , July , i8go. 

" The author has avoided the not uncommon error of writing a 
book on general medicine and labeling it ' Diseases of Children/ 
but has steadily kept in view the diseases which seemed to be 
incidental to childhood, or such points in disease as appear to be so 
peculiar to or pronounced in children as to justify insistence upon 
them. * * * A safe and reliable guide, and in many ways 
admirably adapted to the wants of the student and practitioner." — 
American Journal of Medical Science. 

" Thoroughly individual, original and earnest, the work evi- 
dently of a close observer and an independent thinker, this book, 
though small, as a handbook or compendium is by no means made 
up of bare outlines or standard facts." — The Therapeutic Ga- 
zette. 

" As it is said of some men, so it might be said of some books, 
that they are 'born to greatness.' This new volume has, we 
believe, a mission, particularly in the hands of the younger 
members of the profession. In these days of prolixity in medical 
literature, it is refreshing to meet with an author who knows both 
what to say and when he has said it. The work of Dr. Goodhart 
(admirably conformed, by Dr. Starr, to meet American require- 
ments) is the nearest approach to clinical teaching without the 
actual presence of clinical material that we have yet seen." — New 
York Medical Record, 

Price of each Book, Cloth, $3.00 ; Leather, $3.50. 



THE NEW SERIES OF MANUALS. 



No. 6. PRACTICAL THERAPEUTICS. 

FOURTH EDITION, WITH AN INDEX OF DISEASES. 

Practical Therapeutics, considered with reference to 
Articles of the Materia Medica. Containing, also, an 
Index of Diseases, with a list of the Medicines 
applicable as Remedies. By Edward John Waring, 
m.d., f.r.c.p. Fourth Edition. Rewritten and Re- 
vised by Dudley W. Buxton, m.d., Asst. to the Prof, 
of Medicine at University College Hospital. 

" We wish a copy could be put in the hands of every Student or 
Practitioner in the country. In our estimation, it is the best book 
of the kind ever written." — N. Y. Medical Journal. 

" Dr. Waring's Therapeutics has long been known as one of the 
most thorough and valuable of medical works. The amount of 
actual intellectual labor it represents is immense. . . . An in- 
dex of diseases, with the remedies appropriate for their treatment, 
closes the volume." — Boston Medical and Surgical Reporter. 

" The plan of this work is an admirable one, and one well calcu- 
lated to meet the wants of busy practitioners. There is a remark- 
able amount of information, accompanied with judicious comments, 
imparted in a concise yet agreeable style." — Medical Record. 

No. 7. MEDICAL JURISPRUDENCE AND 
TOXICOLOG-Y. 

THIRD REVISED EDITION. 

By John J. Reese, m.d., Professor of Medical Jurispru- 
dence and Toxicology in the University of Pennsyl- 
vania ; President of the Medical Jurisprudence Society 
of Phila. ; Third Edition, Revised and Enlarged. 

" This admirable text-book." — Amer.Jour. of Med. Sciences. 

u We lay this volume aside, after a careful perusal of its pages, 
with the profound impression that it should be in the hands of every 

doctor and lawyer. It fully meets the wants of all students 

He has succeeded in admirably condensing into a handy volume all 
the essential points." — Cincinnati Lancet and Clinic. 

" The book before us will, we think, be found to answer the ex- 
pectations of the student or practitioner seeking a manual of juris- 
prudence, and the call for a second edition is a flattering testimony 
to the value of the author's present effort. The medical portion 
of this volume seems to be uniformly excellent, leaving little for 
adverse criticism. The information on the subject matter treated 
has been carefully compiled, in accordance with recent knowledge. 
The toxicological portion appears specially excellent. Of that por- 
tion of the work treating of the legal relations of the practitioner 
and medical witness, we can express a generally favorable ver- 
dict." — Physician and Surgeon, Ann Arbor, Mich. 

Price of each Book, Cloth, $3,00 ; Leather, $3.50. 



6 STUDENTS' TEXT-BOOKS AND MANUALS. 

ANATOMY. 

Macalister's Human Anatomy. 816 Illustrations. A new 
Text-book for Students and Practitioners, Systematic and Topo- 
graphical, including the Embryology, Histology and Morphology 
of Man. With special reference to the requirements of 
Practical Surgery and Medicine. With 816 Illustrations, 
400 of which are original. Octavo. Cloth, 7.50; Leather, 8.50 

Ballou's Veterinary Anatomy and Physiology. Illustrated. 
By Wm. R. Ballou, m.d., Professor of Equine Anatomy at New 
York College of Veterinary Surgeons. 29 graphic Illustrations. 
i2mo. Cloth, 1. 00; Interleaved for notes, 1.25 

Holden's Anatomy. A manual of Dissection of the Human 
Body. Fifth Edition. Enlarged, with Marginal References and 
over 200 Illustrations. Octavo. 

Bound in Oilcloth, for the Dissecting Room, $4.50. 
" No student of Anatomy can take up this book without being 
pleased and instructed. Its Diagrams are original, striking and 
suggestive, giving more at a glance than pages of text description. 
* * * The text matches the illustrations in directness of prac- 
tical application and clearness of detail." — New York Medical 
Record. 

Holden's Human Osteology. Comprising a Description of the 
Bones, with Colored Delineations of the Attachments of the 
Muscles. The General and Microscopical Structure of Bone and 
its Development. With Lithographic Plates and Numerous Illus- 
trations. Seventh Edition. 8vo. Cloth, 6.00 

Holden's Landmarks, Medical and Surgical. 4th ed. Clo., 1.25 

Heath's Practical Anatomy. Sixth London Edition. 24 Col- 
ored Plates, and nearly 300 other Illustrations. Cloth, 5.00 

Potter's Compend of Anatomy. Fifth Edition. Enlarged. 
16 Lithographic Plates. 117 Illustrations. See Page 14. 

Cloth, 1. 00; Interleaved for Notes, 1.25 

CHEMISTRY. 

Bartley's Medical Chemistry. Second Edition. A text-book 
prepared specially for Medical, Pharmaceutical and Dental Stu- 
dents. With 50 Illustrations, Plate of Absorption Spectra and 
Glossary of Chemical Terms. Revised and Enlarged. Cloth, 2.50 

Trimble. Practical and Analytical Chemistry. A Course in 
Chemical Analysis, by Henry Trimble, Prof, of Analytical Chem- 
istry in the Phila. College of Pharmacy. Illustrated. Third 
Edition. 8vo. Cloth, 1.50 

JfcS* See pages 2 to 5 for list of Students' Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 7 

Chemistry : — Continued. 

Bloxam's Chemistry, Inorganic and Organic, with Experiments. 
Seventh Edition. Enlarged and Rewritten. 281 Illustrations. 

Cloth, 4.50; Leather, 5.50 

Richter's Inorganic Chemistry. A text-book for Students. 
Third American, from Fifth German Edition. Translated by 
Prof. Edgar F. Smith, ph.d. 89 Wood Engravings and Colored 
Plate of Spectra. Cloth, 2.00 

Richter's Organic Chemistry, or Chemistry of the Carbon 
Compounds. Illustrated. Second Edition. Cloth, 4.50 

Symonds. Manual of Chemistry, for the special use of Medi- 
cal Students. By Brandreth Symonds, a.m., m.d., Asst. 
Physician Roosevelt Hospital, Out-Patient Department ; Attend- 
ing Physician Northwestern Dispensary, New York. i2mo. 

Cloth, 2.00; Interleaved for Notes, 2.40 

Leffmann's Compend of Chemistry. Inorganic and Organic. 
Including Urinary Analysis. Third Edition. Revised. 

Cloth, 1. 00; Interleaved for Notes, 1.25 

Leffmann and Beam. Progressive Exercises in Practical 
Chemistry. i2mo. Illustrated. Cloth, 1.00 

Muter. Practical and Analytical Chemistry. Fourth Edi- 
tion. Revised, to meet the requirements of American Medical 
Colleges, by Prof. C. C. Hamilton. Illustrated. Cloth, 2.00 

Holland. The Urine, Common Poisons, and Milk Analysis, 
Chemical and Microscopical. For Laboratory Use. Fourth 
Edition, Enlarged. Illustrated. Cloth, 1.00 

Van Niiys. Urine Analysis. Illus. Cloth, 2.00 

Wolff's Applied Medical Chemistry. By Lawrence Wolff, 
m.d., Dem. of Chemistry in Jefferson Medical College. Clo., 1.00 

CHILDREN. 

Goodhart and Starr. The Diseases of Children. Second 
Edition. By J. F. Goodhart, m.d., Physician to the Evelina 
Hospital for Children; Assistant Physician to Guy's Hospital, 
London. Revised and Edited by Louis Starr, m.d., Clinical 
Professor of Diseases of Children in the Hospital of the Univer- 
sity of Pennsylvania; Physician to the Children's Hospital, 
Philadelphia. Containing many Prescriptions and Formulae, 
conforming to the U. S. Pharmacopoeia, Directions for making 
Artificial Human Milk, for the Artificial Digestion of Milk, etc. 
Illustrated. Cloth, 3.00; Leather, 3.50 

Hatfield. Diseases of Children. By M. P. Hatfield, m.d., 

Professor of Diseases of Children, Chicago Medical College. 

Colored Plate. i2mo. Cloth, 1. 00; Interleaved, 1.25 

4)®=" See pages 14 and is for list of? Quiz- Compends? 



8 STUDENTS' TEXT-BOOKS AND MANUALS. 

Children: — Continued, 
Starr. Diseases of the Digestive Organs in Infancy and 
Childhood. With chapters on the Investigation of Disease, 
and on the General Management of Children. By Louis Starr, 
m.d., Clinical Professor of Diseases of Children in the Univer- 
sity of Pennsylvania. Illus. Second Edition. Cloth, 2.25 

DENTISTRY. 

Fillebrown. Operative Dentistry. 330 Illus. Cloth, 2.50 

Flagg's Plastics and Plastic Filling. 4th Ed. Cloth, 4.00 
Gorgas. Dental Medicine. A Manual of Materia Medica and 
Therapeutics. Fourth Edition. Cloth, 3.50 

Harris. Principles and Practice of Dentistry. Including 
Anatomy, Physiology, Pathology, Therapeutics, Dental Surgery 
and Mechanism. Twelfth Edition. Revised and enlarged by 
Professor Gorgas. 1028 Illustrations. Cloth, 7.00 ; Leather, 8.00 
Richardson's Mechanical Dentistry. Fifth Edition. 569 
Illustrations. 8vo. Cloth, 4.50; Leather, 5.50 

Sewill. Dental Surgery. 200 Illustrations. 3d Ed. Clo., 3.00 
Taft's Operative Dentistry. Dental Students and Practitioners. 
Fourth Edition. 100 Illustrations. Cloth, 4.25 ; Leather, 5.00 
Talbot. Irregularities of the Teeth, and their Treatment. 
Illustrated. 8vo. Second Edition. Cloth, 3.00 

Tomes' Dental Anatomy. Third Ed. 191 Illus. Cloth, 4.00 
Tomes' Dental Surgery. 3d Edition. Revised. 292 Illus. 
772 Pages. Cloth, 5.00 

Warren. Compend of Dental Pathology and Dental Medi- 
cine. Illustrated. Cloth, 1.00; Interleaved, 1.25 

DICTIONARIES. 

Gould's New Medical Dictionary. Containing the Definition 
and Pronunciation of all words in Medicine, with many useful 
Tables etc. % Dark Leather, 3.25 ; % Mor., Thumb Index 4.25 

Harris' Dictionary of Dentistry. Fifth Edition. Completely 
revised and brought up to date by Prof. Gorgas. 

Cloth, 5.00; Leather, 6.00 

Cleaveland's Pronouncing Pocket Medical Lexicon. 31st 
Edition. Giving correct Pronunciation and Definition. Very 
small pocket size. Cloth, red edges .75 ; pocket-book style, 1.00 

Longley's Pocket Dictionary. The Student's Medical Lexicon, 
giving Definition and Pronunciation of all Terms used in Medi- 
cine, with an Appendix giving Poisons and Their Antidotes, 
Abbreviations used in Prescriptions, Metric Scale of Doses, etc. 
24mo. Cloth, 1. 00; pocket-book style, 1.25 

jfcS=" See Pages 2 to 5 for list of Students' Manuals, 



STUDENTS' TEXT-BOOKS AND MANUALS, 9 

EYE. 

Hartridge on Refraction. 4th Edition. Cloth, 2.00 

Hartridge on the Ophthalmoscope. Nearly Ready. 

Meyer. Diseases of the Eye. A complete Manual for Stu- 
dents and Physicians. 270 Illustrations and two Colored Plates. 
8vo. Cloth, 4.50; Leather, 5.50 

Swanzy. Diseases of the Eye and their Treatment. 158 
Illustrations. Third Edition. Cloth, 3 00 

Fox and Gould. Compend of Diseases of the Eye and 
Refraction. 2d Ed. Enlarged. 71 Illus. 39 Formulae. 

Cloth, 1. 00 ; Interleaved for Notes, 1.25 

ELECTRICITY. 

Bigelow. Plain Talks on Medical Electricity and Batteries. 

Illustrated. With a Glossary of Electrical Terms. Cloth, 1.00 

Mason's Compend of Medical and Surgical Electricity. 

With numerous Illustrations. i2mo. Cloth, 1.00 

HYGIENE. 
Parkes' (Ed. A.) Practical Hygiene. Seventh Edition, en- 
larged. Illustrated. 8vo. Cloth, 4.50 
Parkes' (L. C.) Manual of Hygiene and Public Health. 

Second Edition. i2mo. Cloth, 2.50 

Wilson's Handbook of Hygiene and Sanitary Science. 

Seventh Edition. Revised and Illustrated. In Press. 

MATERIA MEDICA AND THERAPEUTICS. 

Potter's Compend of Materia Medica, Therapeutics and 
Prescription Writing. Fifth Edition, revised and improved. 
See Page 15. Cloth, 1.00; Interleaved for Notes, 1.25 

Biddle's Materia Medica. Eleventh Edition. By the late 
John B. Biddle, m.d., Prof, of Materia Medica in Jefferson Col- 
lege, Philadelphia. Revised by Clement Biddle, m.d., and 
Henry Morris, m.d. 8 vo., illustrated. Cloth, 4.25; Leather, 5.00 

Potter. Handbook of Materia Medica, Pharmacy and 
Therapeutics. Including Action of Medicines, Special Thera- 
peutics, Pharmacology, etc. By Saml. O. L. Potter, m.d., 
m.r.c.p. (Lond.), Professor of the Practice of Medicine in 
Cooper Medical College, San Francisco. Third Edition. 8vo. 

Cloth, 4.00; Leather, 5.00 

Waring. Therapeutics. With an Index of Diseases and 
Remedies. 4th Edition. Revised. Cloth, 3.00; Leather, 3.50 
4^* Seepages 14 and 13 for list of ? Quiz- Cotnpends ? 



10 STUDENTS' TEXT-BOOKS AND MANUALS. 

MEDICAL JURISPRUDENCE. 

Reese. A Text-book of Medical Jurisprudence and Toxi- 
cology. By John J. Reese, m.d., Professor of Medical Juris- 
prudence and Toxicology in the Medical Department of the 
University of Pennsylvania ; President of the Medical Juris- 
prudence Society of Philadelphia; Physician to St. Joseph's 
Hospital ; Corresponding Member of The New York Medico- 
legal Society. Third Edition. Cloth, 3.00; Leather, 3.50 

OBSTETRICS AND GYNECOLOGY. 

Davis. A Manual of Obstetrics. Colored Plates, and 150 
other Illustrations. Ready in October ', i8gi. 

Byford. Diseases of Women. The Practice of Medicine and 
Surgery, as applied to the Diseases and Accidents Incident to 
Women. By W. H. Byford, a.m., m.d., Professor of Gynaecology 
in Rush Medical College and of Obstetrics in the Woman's Med- 
ical College, etc., and Hemy T. Byford, m.d., Surgeon to the 
Woman's Hospital of Chicago. Fourth Edition. Revised and 
Enlarged. 306 Illustrations, over 100 of which are original. 
Octavo. 832 pages. Cloth, 5.00 ; Leather, 6.00 

Cazeaux and Tarnier's Midwifery. With Appendix, by 

Munde. The Theory and Practice of Obstetrics ; including the 
Diseases of Pregnancy and Parturition, Obstetrical Operations, 
etc. Eighth American, from the Eighth French and First 
Italian Edition. Edited by Robert J. Hess, m.d., Physician to 
the Northern Dispensary, Philadelphia, with an appendix by 
Paul F. Munde, m.d., Professor of Gynaecology at the N. Y. 
Polyclinic. Illustrated by Chromo-Lithographs, and other Full- 
page Plates, seven of which are beautifully colored, and numerous 
Wood Engravings. One Vol., 8vo. Cloth, 5.00; Leather, 6.00 

Lewers' Diseases of Women. A Practical Text-Book. 139 
Illustrations. Second Edition. Cloth, 2.50 

Parvin's Winckel's Diseases of Women. Second Edition. 

Including a Section on Diseases of the Bladder and Urethra. 
150 Illus. Revised. See page 3. Cloth, 3.00; Leather, 3.50 

Morris. Compend of Gynaecology. Illustrated. Cloth, 1.00 

Winckel's Obstetrics. A Text-book on Midwifery, includ- 
ing the Diseases of Childbed. By Dr. F. Winckel, Professor 
of Gynaecology, and Director of the Royal University Clinic for 
Women, in Munich. Authorized Translation, by J. Clifton 
Edgar, m.d., Lecturer on Obstetrics, University Medical Col- 
lege, New York, with nearly 200 handsome illustrations, the 
majority of which are original. 8vo. Cloth, 6.00; Leather, 7.00 

Landis' Compend of Obstetrics. Illustrated. 4th edition, 
enlarged. Cloth, 1.00 ; Interleaved for Notes, 1.25 

Galabin's Midwifery. By A. Lewis Galabin, m.d., f.r.c.p. 

227 Illustrations. See page 3. Cloth, 3.00; Leather, 3.50 

Rigby's Obstetric Memoranda. 4th Edition. Cloth, .50 

Jfcg* See pages 2 to 5 for list of 'New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 11 



PATHOLOGY. HISTOLOGY. BIOLOGY. 

Bowlby. Surgical Pathology and Morbid Anatomy, for 
Students. 135 Illustrations. i2mo. Cloth, 2.00 

Davis' Elementary Biology. Illustrated. Cloth, 4.00 

Gilliam's Essentials of Pathology. A Handbook for Students. 
47 Illustrations. i2mo. Cloth, 2.00 

*** The object of this book is to unfold to the beginner the funda- 
mentals of pathology in a plain, practical way, and by bringing 
them within easy comprehension to increase his interest in the study 
of the subject. 

Globes' Practical Histology and Pathology. Third Edition. 

Enlarged. i2mo. Cloth, 1.75 

Virchow's Post-Mortem Examinations. 3d Ed. Cloth, 1.00 

PHYSICAL DIAGNOSIS. 

Fenwick. Student's Guide to Physical Diagnosis. 7th 
Edition. 117 Illustrations. i2mo. Cloth, 2.25 

Tyson's Physical Diagnosis. Illustrated. 

To be ready, October, i8qi. 

PHYSIOLOGY. 

Yeo's Physiology. Fifth Edition. The most Popular Stu- 
dents' Book. By Gerald F. Yeo, m.d., f.r.c.s., Professor of 
Physiology in King's College, London. Small Octavo. 758 
pages. 321 carefully printed Illustrations. With a Full 
Glossary and Index. See Page 3. Cloth, 3.00; Leather, 3.50 

Brubaker's Compend of Physiology. Illustrated. Sixth 
Edition. Cloth, 1.00; Interleaved for Notes, 1.25 

Stirling. Practical Physiology, including Chemical and Ex- 
perimental Physiology. 142 Illustrations. Cloth, 2.25 

Kirke's Physiology. New 12th Ed. Thoroughly Revised and 
Enlarged. 502 Illustrations. Cloth, 4.00; Leather, 5.00 

Landois' Human Physiology. Including Histology and Micro- 
scopical Anatomy, and with special reference to Practical Medi- 
cine. Third Edition. Translated and Edited by Prof. Stirling. 
692 Illustrations. Cloth, 6.50; Leather, 7.50 

" With this Text-book at his command, no student could fail in 

his examination." — Lancet. 

Sanderson's Physiological Laboratory. Being Practical Ex- 
ercises for the Student. 350 Illustrations. 8vo. Cloth, 5.00 

PRACTICE. 

Taylor. Practice of Medicine. A Manual. By Frederick 
Taylor, m.d., Physician to, and Lecturer on Medicine at, Guy's 
Hospital, London ; Physician to Evelina Hospital for Sick Chil- 
dren, and Examiner in Materia Medica and Pharmaceutical 
Chemistry, University of London. Cloth, 4.00; Leather, 5.00 

£g* See pages 14 and 13 for list of ? Qtiiz-Compends f 



12 STUDENTS' TEXT-BOOKS AND MANUALS. 

Practice : — Continued. 

Roberts' Practice. New Revised Edition. A Handbook 
of the Theory and Practice of Medicine. By Frederick T. 
Roberts, m.d. ; m.r.c.p., Professor of Clinical Medicine and 
Therapeutics in University College Hospital, London. Seventh 
Edition. Octavo. Cloth, 5.50; Sheep, 6.50 

Hughes. Compend of the Practice of Medicine. 4th Edi- 
tion. Two parts, each, Cloth, 1.00; Interleaved for Notes, 1.25 
Part i. — Continued, Eruptive and Periodical Fevers, Diseases 

of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 

Kidneys, etc., and General Diseases, etc. 

Part ii. — Diseases of the Respiratory System, Circulatory 

System and Nervous System ; Diseases of the Blood, etc. 
Physicians' Edition. Fourth Edition. Including a Section 
on Skin Diseases. With Index. 1 vol. Full Morocco, Gilt, 2.50 

From John A. Robinson, M.D., Assistant to Chair of Clinical 
Medicine, now Lecturer on Materia Medica, Rush Medical Col- 
lege, Chicago. 
" Meets with my hearty approbation as a substitute for the 

ordinary note books almost universally used by medical students. 

It is concise, accurate, well arranged and lucid, . . . just the 

thing for students to use while studying physical diagnosis and the 

more practical departments of medicine. " 

PRESCRIPTION BOOKS. 

Wythe's Dose and Symptom Book. Containing the Doses 
and Uses of all the principal Articles of the Materia Medica, etc. 
Seventeenth Edition. Completely Revised and Rewritten. Just 
Ready. 32mo. Cloth, 1. 00; Pocket-book style, 1.25 

Pereira's Physician's Prescription Book. Containing Lists 
of Terms, Phrases, Contractions and Abbreviations used in 
Prescriptions Explanatory Notes, Grammatical Construction of 
Prescriptions, etc., etc. By Professor Jonathan Pereira, m.d. 
Sixteenth Edition. 32010. Cloth, 1.00; Pocket-book style, 1.25 

PHARMACY. 

Stewart's Compend of Pharmacy. Based upon Remington's 
Text-Book of Pharmacy. Third Edition, Revised. With new 
Tables, Index, Etc. Cloth, 1.00 ; Interleaved for Notes, 1.25 

Robinson. Latin Grammar of Pharmacy and Medicine. 
By H. D. Robinson, ph.d., Professor of Latin Language and 
Literature, University of Kansas, Lawrence. With an Intro- 
duction by L. E. Sayre, ph.g., Professor of Pharmacy in, and 
Dean of, the Dept. of Pharmacy, University of Kansas. i2mo. 

Cloth, 2.00 

SKIN DISEASES. 

Anderson, (McCall) Skin Diseases. A complete Text-Book, 
with Colored Plates and numerous Wood Engravings. 8vo. 

Cloth, 4.50; Leather, 5.50 

Van Harlingen on Skin Diseases. A Handbook of the Dis- 
eases of the Skin, their Diagnosis and Treatment (arranged alpha- 
betically). By Arthur Van Harlingen, m.d., Clinical Lecturer 
on Dermatology, Jefferson Medical College; Prof, of Diseases of 
the Skin in the Philadelphia Polyclinic. 2d Edition. Enlarged. 
With colored and other plates and illustrations. i2mo. Cloth, 2.50 
.0®* See pages 2 to 5 for list of New Manuals. 



STUDENTS' TEXT-BOOKS AND MANUALS. 13 
SURGERY AND BANDAGING. 

Moullin's Surgery, A new Text-Book. 500 Illustrations, 200 of 
which are original. Cloth, 7.00 ; Leather, 8.00 

Jacobson. Operations in Surgery. A Systematic Handbook 
for Physicians, Students and Hospital Surgeons. By W. H. A. 
Jacobson, b.a., Oxon. f.r.c.s. Eng. ; Ass't Surgeon Guy's Hos- 
pital ; Surgeon at Royal Hospital for Children and Women, etc. 
199 Illustrations. 1006 pages. 8vo. Cloth. 5.00; Leather, 6.00 

Heath's Minor Surgery, and Bandaging. Ninth Edition. 142 
Illustrations. 60 Formulae and Diet Lists. Cloth, 2.00 

Horwitz's Compend of Surgery, Minor Surgery and 
Bandaging, Amputations, Fractures, Dislocations, Surgical 
Diseases, and the Latest Antiseptic Rules, etc., with Differential 
Diagnosis and Treatment. By Orville Horwitz, b.s., m.d., 
Demonstrator of Surgery, Jefferson Medical College. 4th edition. 
Enlarged and Rearranged. 136 Illustrations and 84 Formulae. 
i2mo. Cloth, 1. 00 ; Interleaved for the addition of Notes, 1.25 
*^*The new Section on Bandaging and Surgical Dressings, con- 
sists of 32 Pages and 41 Illustrations. Every Bandage of any 
importance is figured. This, with the Section on Ligation of 
Arteries, forms an ample Text-book for the Surgical Laboratory. 

Walsham. Manual of Practical Surgery. For Students and 
Physicians. By Wm. J. Walsham, m.d., f.r.c.s., Asst. Surg, 
to, and Dem. of Practical Surg, in, St. Bartholomew's Hospital, 
Surgeon to Metropolitan Free Hospital, London. With 236 
Engravings. See Page 2. Cloth, 3.00; Leather, 3.50 

URINE, URINARY ORGANS, ETC. 

Holland. The Urine, and Common Poisons and The 
Milk. Chemical and Microscopical, for Laboratory Use. Illus- 
trated. Fourth Edition. i2mo. Interleaved. Cloth, 1.00 

Ralfe. Kidney Diseases and Urinary Derangements. 42 Illus- 
trations. i2mo. 572 pages. Cloth, 2.75 

Marshall and Smith. On the Urine. The Chemical Analysis of 
the Urine. By John Marshall, m.d., Chemical Laboratory, Univ. 
of Penna; and Prof. E. F. Smith, ph.d. Col. Plates. Cloth, 1.00 

Tyson. On the Urine. A Practical Guide to the Examination 
of Urine. With Colored Plates and Wood Engravings. 7th Ed. 
Enlarged. i2mo. Cloth, 1.50 

Van Niiys, Urine Analysis. Illus. Cloth, 2.00 

VENEREAL DISEASES. 

Hill and Cooper. Student's Manual of Venereal Diseases, 
with Formulae. Fourth Edition. 12m©. Cloth, 1.00 

££^~ See pages 14 and /j for list of ? Quiz- Comp ends f 



NEW AND REVISED EDITIONS. 

PQUIZ-COMPENDS? 

The Best Compends for Students' Use 
in the Quiz Class, and when Pre- 
paring for Examinations. 

Compiled in accordance with the latest teachings ofpromi- 
nent lecturers and the most popular Text-books. 

They form a most complete, practical and exhaustive 
set of manuals, containing information nowhere else col- 
lected in such a condensed, practical shape. Thoroughly 
up to the times in every respect, containing many new 
prescriptions and formulae, and over two hundred and 
fifty illustrations, many of which have been drawn and 
engraved specially for this series. The authors have had 
large experience as quiz-masters and attaches of colleges, 
with exceptional opportunities for noting the most recent 
advances and methods. 

Cloth, each $1.00. Interleaved for Notes, $1.25. 
No. 1. HUMAN ANATOMY, " Based upon Gray." Fifth 
Enlarged Edition, including Visceral Anatomy, formerly 
published separately. 16 Lithograph Plates, New 
Tables and 117 other Illustrations. By Samuel O. L. 
Potter, m.a., m.d., m.r.c.p. (Lond.,) late A. A. Surgeon U. S. 
Army. Professor of Practice, Cooper Medical College, San Fran- 
cisco. 
Nos. 2 and 3. PRACTICE OF MEDICINE. Fourth Edi- 
tion. By Daniel E. Hughes, m.d., Demonstrator of Clinical 
Medicine in Jefferson Medical College, Philadelphia. In two parts. 
Part I. — Continued, Eruptive and Periodical Fevers, Diseases 
of the Stomach, Intestines, Peritoneum, Biliary Passages, Liver, 
Kidneys, etc. (including Tests for Urine), General Diseases, etc. 

Part II. — Diseases of the Respiratory System (including Phy- 
sical Diagnosis), Circulatory System and Nervous System; Dis- 
eases of the Blood, etc. 

*** These little books can be regarded as a full set of notes upon 
the Practice of Medicine, containing the Synonyms, Definitions, 
Causes, Symptoms, Prognosis, Diagnosis, Treatment, etc., of each 
disease, and including a number of prescriptions hitherto unpub- 
lished. 

No. 4. PHYSIOLOGY, including Embryology. Sixth 
Edition. By Albert P. Brubaker, m.d., Prof, of Physiology, 
Penn'a College of Dental Surgery; Demonstrator of Physiology 
in Jefferson Medical College, Philadelphia. Revised, Enlarged, 
with new Illustrations. 
No. 5. OBSTETRICS. Illustrated. Fourth Edition. By 
Henry G. Landis, m.d., Prof, of Obstetrics and Diseases of 
Women, in Starling Medical College, Columbus, O. Revised 
Edition. New Illustrations. 



BLAKISTON'S ? QUIZ-COMPEXDS ? 

No. 6. MATERIA MEDICA, THERAPEUTICS AND 
PRESCRIPTION WRITING. Fifth Revised Edition. 
With especial Reference to the Physiological Action of Drugs, 
and a complete article on Prescription Writing. Based on the 
Last Revision of the U. S. Pharmacopoeia, and including many 
unofficinal remedies. By Samuel O. L. Potter, m.a., m.d., 
m.r.c.p. (Lond.,) late A. A. Surg. U. S. Army ; Prof, of Practice, 
Cooper Medical College, San Francisco. Improved and Enlarged, 
with Index. 

No. 7. GYNAECOLOGY. A Compend of Diseases of Women. 
By Henry Morris, m.d., Demonstrator of Obstetrics, Jefferson 
Medical College, Philadelphia. 45 Illustrations. 

No. 8. DISEASES OF THE EYE AND REFRACTION, 

including Treatment and Surgery. By L. Webster Fox, m.d., 
Chief Clinical Assistant Ophthalmological Dept., Jefferson Med- 
ical College, etc., and Geo. M. Gould, m.d. 71 Illustrations, 39 
Formulae. Second Enlarged and Improved Edition. Index. 

No. 9. SURGERY, Minor Surgery and Bandaging. Illus- 
trated. Fourth Edition. Including Fractures, Wounds, 
Dislocations, Sprains, Amputations and other operations ; Inflam- 
mation, Suppuration, Ulcers, Syphilis, Tumors, Shock, etc. 
Diseases of the Spine, Ear, Bladder, Testicles, Anus, and 
other Surgical Diseases. By Orville Horwitz, a.m., m.d., 
Demonstrator of Surgery, Jefferson Medical College. Revised 
and Enlarged. 84 Formulae and 136 Illustrations. 

No. 10. CHEMISTRY. Inorganic and Organic. For Medical 
and Dental Students. Including Urinary Analysis and Medical 
Chemistry. By Henry Leffmann, m.d., Prof, of Chemistry in 
Penn'a College of Dental Surgery, Phila. Third Edition, Revised 
and Rewritten, with Index. 

No. 11. PHARMACY. Based upon M Remington's Text-book 
of Pharmacy." By F. E. Stewart, m.d., ph. g., Quiz-Master 
at Philadelphia College of Pharmacy. Third Edition, Revised. 

No. 12. VETERINARY ANATOMY AND PHYSIOL- 
OGY. 29 Illustrations. By Wm. R. Ballou, m.d., Prof, of 
Equine Anatomy at N. Y. College of Veterinary Surgeons. 

No. 13. DENTAL PATHOLOGY AND DENTAL MEDI- 
CINE. Containing all the most noteworthy points of interest 
to the Dental student. By Geo. W. Warren, d.d.s., Clinical 
Chief, Penn'a College of Dental Surgery, Philadelphia. Illus. 

No. 14. DISEASES OF CHILDREN. By Dr. Marcus P. 
Hatfield, Prof, of Diseases of Children, Chicago Medical 
College. Colored Plate. 

Bound in Cloth, $1. Interleaved, for the Addition of Notes, $1.25. 



These books are constantly revised to keep up with 
the latest teachings and discoveries, so that they contain 
all the new methods and principles. No series of books 
are so complete in detail, concise in language, or so well 
printed and bound. Each one forms a complete set of 
notes upon the subject under consideration. 

Illustrated Descriptive Circular Free. 



JUST PUBLISHED. 



GOULD'S NEW 

Medical Dictionary 




compact. 



CONCISE. 



PRACTICAL. 



ACCURATE. 



COMPREHENSIVE 



UP TO DATE. 



It contains Tables of the Arteries, Bacilli, Gan- 
glia, Leucomaines, Micrococci, Muscles, 
Nerves, Plexuses, Ptomaines, etc., 
etc., that will be found of great 
use to the student. 



Small octavo, 520 pages, Half-Dark Leather, . $3.25 
With Thumb Index, Half Morocco, marbled edges, 4.25 



From J. M. DaCOSTA, M. D., Professor of Practice and 
Clinical Medicine, Jefferson Medical College, Philadelphia. 

"I find it an excellent work, doing credit to the learning and 
discrimination of the author." 

*** Sample Pages free. 



